老年急性髓系白血病患者中医证型分布、遗传学检查及预后的临床分析

Traditional Chinese medicine syndrome,genetic testing and prognosis analysis of elderly patients with acute myeloid leukemia

目的观察老年急性髓系白血病(AML)患者中医证型分布、遗传学检查及预后的关系。方法回顾性分析59例老年AML患者的中医证型、基因检测、染色体检查结果及生存期资料。结果59例老年AML患者中医证型以邪盛正虚证、气血两虚证为主。染色体突变的例数在气血两虚、邪盛正虚患者中比较差异有统计学意义(P<0.05)。存在WT1基因突变与未存在WTI基因突变组、国际血栓与止血协会(ISTH)评分<5分与≥5分组、<4分与≥4分组、D-二聚体(D-D)≤1 mg/L与>1 mg/L组、存在出凝血异常与不存在出凝血异常组,患者中位总生存期(OS)比较差异均有统计学意义(P<0.05)。结论染色体检查或有助于区别老年AML患者中医证型,WT1基因突变,D-D及ISTH评分对评价预后有一定意义。

Objective To investigate the correlation between the traditional Chinese medicine(TCM)syndrome,genetic testing and the prognosis of elderly patients with acute myeloid leukemia(AML).Methods TCM syndromes,genetic testing,chromosomal examination,and survival data of 59 elderly patients with AML were retrospectively analyzed.Results The TCM syndromes of the patients were dominated by the presence of deficiency of qi and Blood,deficient vital qi and excess pathogenic qi.There was a significant difference in the number of chromosomal mutations between deficiency of qi and blood and deficient vital qi and excess Pathogenic qi(P<0.05).A significant difference in the medial overall survival was detected in elderly AML patients classified by the presence of WT1 gene mutation,the International Society on Thrombosis and Haemostasis(ISTH)(ISTH score<5 versus≥5),D-dimer(D-D)(≤1 mg/L versus>1 mg/L),the presence of coagulation disorder,the median overall survival(OS)(all P<0.05).Conclusion Chromosomal examination may help to distinguish the TCM syndrome,WT1 gene mutation,D-D and ISTH score in elderly AML patients,which contributes to predict their prognosis.