中医药防治骨髓增生异常综合征研究述评

Comment on the research of accurate prevention and treatment of myelodysplastic syndrome with Traditional Chinese Medicine

回顾分析当前中医药防治骨髓增生异常综合征(MDS)研究现状,并通过长期临床实践,提出“虚毒并治”理论下的MDS中医药防治模式,主要内容包括:根据不同治疗反应和转化风险进行分层防治——通过整体、动态、连续地防治MDS发生、发展、治疗及转归全过程;监测导致MDS的前驱疾病,包括意义未明的特发性血细胞减少症、意义未明的克隆性血细胞减少症等,以刺激造血为治疗目标,治以补虚为主、兼以解毒,以抑制克隆、阻止或延缓向MDS进展;治疗较低危MDS,以抑制克隆与刺激造血并重,治以补虚解毒,以提升血象和提高临床缓解率;控制较高危MDS,以抑制克隆为治疗目标,治以解毒为主、兼以补虚,以延长向白血病转化和复发耐药时间;在“扶正祛邪、攻补守衡”聚焦主病、主证基础上,注重“固本祛邪”全病程管理,积极预防和治疗相关并发症,提高临床疗效与生存质量,恢复机体功能状态,降低治疗成本,使更多的患者获益。同时提出,现有中医药治疗和能体现中西医协同优势的临床文献级别有限,亟待多中心、大样本、严格随机对照、高质量的临床研究,获得更多高质量循证医学证据。

The current status of research on the prevention and treatment of myelodysplastic syndrome(MDS) withTraditional Chinese Medicine(TCM) was reviewed and analyzed,and through long-term clinical practice,aprecise TCM-based prevention and treatment strategy based on the theory of combination of deficiency and toxin was proposed.The main contents included:(i) precise layered prevention and treatment according to different treatment reactions and conversion risks,through the overall,dynamic,continuous,and accurate prevention and treatment of MDS,affecting the whole process of its occurrence,development,treatment,and outcome;and(ii) to monitor the prodromal diseases pre-MDS,includingIdiopathic cytopenia of undetermined significance(ICUS)andClonal cytopenia of undetermined significance(CCUS),which cause MDS,with the stimulation of hematopoiesis as the treatment target and the treatment is mainly based on tonifying deficiency,accompanied by detoxification,in order to inhibit cloning and prevent or delay the progression to MDS;and(iii) treating lower-risk MDS,emphasis is placed on inhibition of cloning and stimulation of hematopoiesis,while treating tonifying deficiency and detoxicating,thereby improving routine blood test values and the clinical remission rate;and(iv) controlling higher-risk MDS,inhibition of cloning is applied as the treatment strategy,in combination with detoxification as the main therapy and tonifying deficiency at the same time to prolong the time of transformation to leukemia and relapse drug resistance.Based on the focus on the main disease and the main goal of “strengthening the body resistance to eliminate pathogenic factors,attacking,supplementing,and maintaining balance,” the whole course management of “consolidating the root and eliminating pathogenic factors” was emphasized,relevant complications were actively prevented and treated,clinical efficacy and quality of life were improved,body function was restored,and treatment costs were reduced,so that more patients could benefit.At the same time,it was pointed out that the existing clinical literature concerning precision treatment with TCM that could reflect the synergistic advantages of TCM and Western medicine was limited in scope,and there is an urgent need for clinical research that is multi-centered,large in sample size,strictly randomized controlled,and of high quality to develop more high-quality evidence-based medicine.