More Benefits of Oral Administration of Arsenic-containing Qinghuang Powder Compared with Decitabine for High/Very-high Risk Myelodysplastic Syndrome

OBJECTIVE: To evaluated the benefits of oral administration of arsenic-containing Qinghuang Powder(QHP)compared with decitabine for patients with high/very-high(H/VH) risk myelodysplastic syndrome(MDS) according to the Revised International Prognostic Score System. METHODS: The OS(mOS) rate, annual OS rate and progression to acute myeloid leukemia(AML) in patients with H/VH MDS treated with QHP(QHP group, n = 27) and decitabine(decitabine group, n = 20) were retrospectively analyzed. The effects of prognostic factors of age, proportion of bone marrow blast,peripheral blood cell count, karyotype and Charlson Comorbidity Index(CCI) on OS were further analyzed. RESULTS: The m OS rate of QHP group(29 months) was signi?cantly longer than that of the decitabine group(18 months)(P = 0.043). The OS rates of 1, 2, and 3 years were signi?cantly higher in the QHP group(88.9%, 59.3%, 29.6%) than that in the decitabine group(70%, 25%, and 5%)(P = 0.01). There was no signi?cant difference of 5-year OS rate between the 2 groups(P = 0.133).The effects of prognostic factors on mOS were further analyzed, and it was found that there was no signi?cant difference of m OS rate between the QHP group(29 months) and the decitabine group(21 months) in the patients with age 65 years old(P = 0.673). The mOS rate was signi?cantly longer in QHP group(28.5 months) than that in decitabine group(18 months) in the patients with age of < 65 years old(P = 0.04). The proportions of bone marrow blast cells with 10% or < 10% had no signi?cant effects on the mOS rate of patients in the 2 groups(P = 0.429, P = 0.183). In patients with HGB 80 g/L, mOS rate was signi?cantly longer in the QHP group(57 months) than that in the decitabine group(21 months)(P = 0.047), while in patients with HGB < 80 g/L, there was no signi?cant difference of mOS rate between the 2 groups(P = 0.265). In the patients with PLT < 50×10~9/L, the mOS rate was signi?cantly longer in the QHP group(33 months) than that in the decitabine group(16 months)(P = 0.028). In the patients with PLT 50×10~9/L, there was no signi?cant difference of the mOS rate between the 2 groups(P = 0.338). In the patients with ANC < 0.8×10~9/L, the mOS rate was signi?cantly longer in the QHP group(20 months) than that in the decitabine group(7 months)(P = 0.014). In the patients with normal karyotype, the mOS was signi?cantly longer in the QHP group(32 months) than that in the decitabine group(15 months)(P = 0.009). In the patients with abnormal karyotypes, there was no significant difference of the mOS rate between the 2 groups(P = 0.882). In the patients with good karyotypes, the mOS rate was signi?cantly longer in the QHP group(37 months) than that in the decitabine group(20 months)(P = 0.019). In the patients with moderate/poor/very poor karyotype, there was no signi?cant difference of the mOS rate between the 2 groups(P = 0.685). In the patients with CCI 3, the mOS rate was signi?cantly longer in the QHP group(34 months) than that in the decitabine group(10.5 months)(P = 0.017). In patients with CCI < 3, there was no signi?cant difference of the mOS rate between the 2 groups(P = 0.581). The proportion of progression to AML in the QHP group(18.8%) was signi?cantly lower than that in the decitabine group(25%)(P = 0.03). CONCLUSION: Compared with decitabine, oral administration of arsenic-containing Qinghuang Powder could help patients to survive longer and decrease incidence of progression to acute myeloid leukemia in the treatment of patients with high/very high MDS.

Clinical Observation of the Treatment of Myelodysplastic Syndrome Mainly with Qinghuang Powder(青黄散)

Objective： To observe the clinical effectiveness of Qinghuang Powder （青黄散, QHP） combined with Bupi Yishen Decoction （补脾益肾汤 BPYS） in treating myelodysplastic syndrome （MDS）, and its relationship with France, America, and Britain （FAB） type, international prognosis scaling system （IPSS） risk, and chromosome karyotype. Methods： There were 124 MDS patients subjected to the tests. By FAB typing, 91 patients were typed as refractory anemia （RA） type and 33 as refractory anemia with excess of blasts （RAEB） type; by IPSS scale, 21 were sorted to low risk, 77 to moderate risk I, 20 to moderate risk ]], and 6 to high risk; 78 of them had normal chromosome and 46 with abnormal chromosome, including 26 of trisomy 8. All patients were treated with QHP＋BPYS, and the changes of peripheral blood figure and bone marrow were observed. Results： After treatment, the general effective rate was 72.58% （90/124）, which in the patients of RA type was 80.22% （73/91） and in RAEB type 51.52% （17/33）. The former was better than that in the later （P〈0.01）. For the analysis in the patients of different IPSS risk degrees, the effective rate was 95.24% （20/21） in the low- risk group, 72.73% （56/77） in moderate risk I, 65.00% （13/20） in moderate-risk 11, and 16.67% （1/6） in high- risk group. Those in the first two groups were superior to that in the latter two （P〈0.01）. The effective rate was 79.49% （61/78） in the patients with normal chromosome and was 60.87% （28/46） in the patients with abnormal chromosome, showing a significant difference between them. While in the patients of trisomy 8, it was 73.08% （19/26）, which was parallel to that in the patients with normal chromosome. Conclusion： The effectiveness of QHP＋BPYS comprehensive therapy for MDS is unquestionably good, and it is markedly correlated with the FAB type and IPSS risk degree of the disease, as well as the normality of chromosome in the patient.

Effect of Qinghuang Powder(青黄散) Combined with Bupi Yishen Decoction(补脾益肾方) in Treating Patients with Refractory Cytopenia with Multilineage Dysplasia through Regulating DNA Methylation

Objective: To explore the effect of Qinghuang Powder(QHP, 青黄散) combined with Bupi Yishen Decoction(BPYS, 补脾益肾方)on myelodysplastic syndromes(MDS) patients with refractory cytopenia with multilineage dysplasia(RCMD) and determine the change of DNA methylation in MDS-RCMD patients after the treatment of Chinese medicine formula. Methods: All 308 MDS-RCMD patients were treated with QHP combined with BPYS for 2 months at least, absolute neutrophil count(ANC), hemoglobin(Hb), platelets(PLT), primitive bone marrow cells and chromosome karyotype were chosen as the main evaluation indexes to analyze the treatment effect according to criteria from the MDS International Working Group. Then 43 bone marrow samples from 15 MDS-RCMD patients and 28 healthy donors were obtained for the examination of DNA methylation.Gene Ontology(GO) and Pathway analysis were applied to analyze the methylation data. Results: The overall MDS response rate to QHP was 61.68%(190/360) including hematologic improvement-neutrophil(HI-N) or hematologic improvement-erythroid(HI-E) or hematologic improvement-platelet(HI-P). Patients with anemia had a better response rate than patients with neutropenia or thrombocypenia(55.88% vs 31.54% or 55.88%vs. 36.9%). The DNA methylation microarray analysis disclosed that 4,257 hypermethylated genes were demethylated upon the treatment with QHP and BPYS. GO analysis and Pathway analysis showed that these demethylated genes were involved in a lot of tumor-related pathways and functions. Conclusions: QHP combined with BPYS could effectively treat MDS-RCMD patients through hematologic improvement(HI-N, HI-P or HI-E)and PLT and RBC transfusion independence due to the demethylation, thereby providing another choice for the treatment of patients with MDS-RCMD.

Relation of Blood Arsenic Concentration with Effect and Safety of Arsenic-Containing Qinghuang Powder (青黄散) in Patients with Myelodysplastic Syndrome

Objective: To investigate the relation of blood arsenic concentration (BAC) with clinical effect and safety of arsenic-containing Qinghuang Powder (青黄散,QHP) in patients with myelodysplastic syndrome (MDS). Methods: Totally 163 patients with MDS were orally treated with QHP for 2 courses of treatment, 3 months as 1 course. The BACs of patients were detected by atomic fluoresce nee spectrophotometry at 1, 3, and 6 months during the treatment, and the effective rate, hematological improvement and safety in patients after treatment with QHP were analyzed. Results: After 2 courses of treatment, the total effective rate was 89.6%(146/163), with 31.3%(51/163) of hematological improvement and 58.3%(95/163) of stable disease. The hemoglobin increased from 73.48 ± 19.30 g/L to 80.39 ± 26.56 g/L (P<0.05), the absolute neutrophil count increased from 0.81 ±0.48 × 10^9/L to 1.08 ±0.62 × 1O^9/L (P<0.05), and no significant changes were observed in platelet counts (P>0.05). Among 46 patients previously depended on blood transfusion, 28.3%(13/46) completely got rid of blood transfusion and 21.7%(10/46) reduced the volume of blood transfusion by more than 50% after treatment. The BACs were significantly increased in patients treated for 1 month with 32.17 ± 18.04 jig/L (P<0.05), 3 months with 33.56 ±15.28 μg/L (P<0.05), and 6 months with 36.78 ±11.92 μg/L (P<0.05), respectively, as compared with those before treatment (4.08 ±2.11 ag/L). There were no significant differences of BACs among the patients treated for 1, 3 and 6 months (P>0.05). The adverse reactions of digestive tract during the treatment were mild abdominal pain and diarrhea in 14 cases (8.6%), and no patients discontinued the treatment. The BACs of patients with gastrointestinal adverse reactions were significantly lower than those without gastrointestinal adverse reactions (22.39 ±10.38 vs. 37.89 ± 11.84,μg/L, P<0.05). The BACs of patients with clinical effect were significantly higher than those failed to treatment (40.41 ± 11.69 vs. 23.84 ± 12.03,μg/L, P<0.05). Conclusion: QHP was effective and safe in the treatment of patients with MDS and the effect was associated with BACs of patients.

Arsenic-Containing Qinghuang Powder(青黄散)Is An Alternative Treatment for Elderly Acute Myeloid Leukemia Patients Refusing Low-Intensity Chemotherapy

Objective:To analyze the overall survival(OS)of elderly acute myeloid leukemia(AML)patients treated with oral arsenic-containing Qinghuang Powder(青黄散,QHP)or low-intensity chemotherapy(LIC).Methods:Forty-two elderly AML patients treated with intravenous or subcutaneous LIC(1 month for each course,at least 3 courses)or oral QHP(3 months for each course,at least 2 courses)were retrospectively analyzed from January 2015 to December 2017.The main endpoints of analysis were OS and 1-,2-,3-year OS rates of patients,respectively.And the adverse reactions induding bone marrow suppression,digestive tract discomfort and myocardia injury were observed.Results:Out of 42 elderly AML patients,22 received LIC treatment and 20 received QHP treatment,according to patients'preference.There was no significant difference on OS between LIC and QHP patients(13.0 months vs.13.5 months,P>0.05).There was no significant difference on OS rates between LIC and QHP groups at 1 year(59.1%vs.70.0%),2 years(13.6%vs.15%),and 3 years(4.6%vs.5.0%,all P>0.05).Furthermore,there was no significant difference of OS on prognosis stratification of performance status>2(12 months vs.12 months),age>75 year-old(12.0 months vs.12.5 months),hematopoietic stem cell transplant comorbidity index>2(12 months vs.13 months),poor cytogenetics(12 months vs.8 months),and diagnosis of secondary AML(10 months vs.14 months)between LIC and QHP patients(P>0.05).Conclusion:QHP may be an alternative treatment for elderly AML patients refusing LIC therapy.

Oral Arsenic-Containing Qinghuang Powder:A Potential Drug for Myelodysplastic Syndromes

Qinghuang Powder(QHP),an oral arsenic,has become an effective drug in the treatment of myelodysplastic syndromes(MDS)in Xiyuan Hospital,China Academy of Chinese Medical Sciences for many years,and the action mechanism of the compound or active ingredient AsSof QHP has been elucidated.Considering the relatively safety,chemotherapy-free and convenient oral profile,QHP is widely used in the clinical treatment for MDS patients,especially for elderly patients.In this review,the authors document the efficacy and safety of oral arsenic-containing compound QHP in the treatment of MDS,with a special focus on the association of efficacy of QHP with the cytogenetics,prognostic risk,DNA methylation,gene mutation,blood arsenic concentration,mechanism of action of AsSand the countermeasures against adverse reactions of gastrointestinal tract.

Comparing Arsenic-Containing Qinghuang Powder and Low-Intensity Chemotherapy in Elderly Patients with Acute Myeloid Leukemia

Objective To compare the clinical effect of arsenic-containing Qinghuang Powder(QHP)and low-intensity chemotherapy(LIC)in treatment of elderly acute myeloid leukemia(eAML)patients.Methods Clinical data of 80 eAML patients treated at Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2015 to December 2020 were retrospectively analyzed.The treatment scheme was designed by real world study according to patients’preference,and patients were divided into a QHP group(35 cases)and a LIC group(45 cases).The median overall survival(mOS),1-,2-,and 3-year OS rates,and incidence of adverse events were compared between the two groups.Results The mOS of 80 patients was 11 months,and the 1-,2-,and 3-year OS rates were 45.51%,17.96%,and 11.05%,respectively.The QHP and LIC groups demonstrated no significant difference in mOS(12 months vs.10 months),1-(48.57%vs.39.65%),2-(11.43%vs.20.04%),and 3-year OS rates(5.71%vs.13.27%,all P>0.05).Moreover,the related factors of mOS demonstrated no significant difference in patients with age>75 years(11 months vs.8 months),secondary AML(11 months vs.8 months),poor genetic prognosis(9 months vs.7 months),Eastern Cooperative Oncology Group performance status score≥(10 months vs.7 months)and hematopoietic stem cell transplant comorbidity index≥4(11 months vs.7 months)between the QHP and LIC groups(all P>0.05).However,the incidence of myelosuppression was significantly lower in the QHP group than that in the LIC group(28.57%vs.73.33%,P<0.01).Conclusions QHP and LIC had similar survival rates in eAML patients,but QHP had a lower myelosuppression incidence.Hence,QHP can be an alternative for eAML patients who do not tolerate LIC.

青黄散治疗髓系肿瘤的临床研究进展

髓系肿瘤(Myeloid neoplasms)是一组异质性疾病,肿瘤细胞起源于骨髓中具有多向分化潜能的造血干细胞,并出现克隆性增殖。从20世纪70年代中期开始,诸多经典中药方剂,临床运用效果明显,而青黄散作为代表,通过大量临床数据证实该方治疗髓系肿瘤有效,为古方中药的发掘与研究提供指引,然而如何将中医的研究成果科学化、全球化,是机遇也是挑战。

含砷中药青黄散方案治疗超高龄伴TP53突变高危骨髓增生异常综合征1例并文献复习

骨髓增生异常综合征(MDS)是起源于造血干细胞的克隆性、髓系肿瘤性疾病,其伴原始细胞增多亚型及伴肿瘤蛋白53(TP53)基因突变均与高危疾病预后分层相关,其中TP53基因突变还与治疗耐药相关。高龄MDS患者的器官功能下降,合并症多,移植不可行,且多数不能耐受化疗、去甲基化药物治疗。患者为超高龄男性,确诊MDS伴原始细胞增多Ⅰ型,初诊时全血细胞进行性下降且需输血支持,修订版国际预后评分系统极高危,伴TP53基因突变。与同类患者比较,应用含砷中药青黄散方案治疗后中位生存期延长,血象三系有不同程度改善,生活质量提高,未发生治疗相关不良反应,耐受性良好,达到高龄MDS患者提高生活质量、延长生存期的治疗目标。本文回顾患者病历资料及应用含砷中药青黄散方案治疗过程,并结合国内外相关文献对高龄MDS的临床特点、治疗方法及相关基因突变特征进行分析,以期为高龄或超高龄预后不良MDS患者的治疗提供借鉴。

青黄散灌胃对骨髓增生异常综合征小鼠骨髓细胞凋亡、周期的影响及机制

目的探讨青黄散灌胃对骨髓增生异常综合征(MDS)小鼠骨髓细胞凋亡、周期的影响及机制。方法用Tg(Vav1-NUP98/HOX D13)G2Apla/J转基因MDS小鼠模型进行取精扩繁,将40只模型小鼠随机分为模型组和青黄散低、中、高剂量组及阿扎胞苷组,每组8只,取8只C57BL/6J小鼠作为空白组。空白组、模型组给予生理盐水100μL灌胃,均每天1次;青黄散低、中、高剂量组分别给予青黄散36.4、72.8、145.6 mg/kg灌胃,均每天1次;阿扎胞苷组给予1 mg/kg阿扎胞苷注射液100μL于颈部皮下注射,3天1次。干预4周,处死小鼠,采集外周血,并提取骨髓细胞。检测各组血常规[白细胞(WBC)、红细胞(RBC)、血红蛋白(HGB)、血小板(PLT)],用流式细胞术检测骨髓细胞凋亡率、周期,用荧光定量PCR法检测骨髓细胞内DNA-甲基转移酶1(DNMT-1)、受体酪氨酸激酶(c-KIT)、GATA结合蛋白1(GATA-1)mRNA,用Western blotting法检测骨髓细胞内DNMT-1、c-KIT、GATA-1蛋白。结果与空白组比较,模型组WBC、RBC、HGB、PLT低(P均<0.05),说明建模成功;与模型组比较,青黄散低、中剂量组及阿扎胞苷组WBC、RBC、HGB、PLT高(P均<0.05);青黄散低、中、高剂量组及阿扎胞苷组WBC、RBC、HGB、PLT比较差异无统计学意义(P均>0.05)。与空白组比较,模型组骨髓细胞凋亡率低(P<0.05);与模型组比较,青黄散低、中、高剂量组及阿扎胞苷组骨髓细胞凋亡率高(P均<0.05)。与空白组比较,模型组骨髓细胞周期变化差异有统计学意义(P均<0.05);与模型组比较,青黄散低、中、高剂量组及阿扎胞苷组S期骨髓细胞少,G1期骨髓细胞多(P均<0.05)。与空白组比较,模型组DNMT-1、c-KIT、GATA-1 mRNA表达低(P均<0.05);与模型组比较,青黄散低、中、高剂量组及阿扎胞苷组DNMT-1、GATA-1 mRNA表达低(P均<0.05),青黄散低、中剂量组c-KIT mRNA表达高(P均<0.05)。与空白组比较,模型组DNMT-1、c-KIT、GATA-1蛋白表达低(P均<0.05);与模型组比较,青黄散低、中、高剂量组及阿扎胞苷组c-KIT蛋白表达低(P均<0.05),GATA-1蛋白表达高(P均<0.05),青黄散低、中、高剂量组DNMT-1蛋白表达低(P均<0.05)。结论青黄散灌胃可促进MDS小鼠骨髓细胞凋亡,阻滞其细胞周期,其作用机制可能与调控DNMT-1、c-KIT、GATA-1表达有关。

清黄颗粒治疗新生儿黄疸的效果

目的 探讨清黄颗粒对新生儿黄疸临床疗效的影响。方法 选取山东省立第三医院2021年1月至12月收治的144例新生儿黄疸患儿,依据随机数字表法将其分为对照组和观察组,每组72例。对照组给予蓝光治疗,观察组在对照组的基础上联合清黄颗粒口服治疗,治疗周期为5 d。比较两组临床疗效;比较两组治疗前后血清总胆红素、直接胆红素、间接胆红素、免疫球蛋白(Ig)A、Ig G、黄疸指数;比较两组黄疸消退时间、蓝光治疗时间、蓝光治疗费用及住院时间;记录两组治疗期间不良反应发生情况。结果 观察组临床疗效优于对照组(P<0.05)。治疗后,两组总胆红素、间接胆红素水平低于治疗前,且观察组低于对照组(P<0.05);两组治疗前后直接胆红素水平比较,差异无统计学意义(P>0.05)。治疗后,两组Ig A、Ig G水平高于治疗前,且观察组高于对照组(P<0.05)。治疗后,两组黄疸指数低于治疗前,且观察组低于对照组(P<0.05);观察组黄疸消退时间、蓝光治疗时间、住院时间短于对照组,蓝光治疗费用低于对照组(P<0.05)。观察组不良反应总发生率低于对照组(P<0.05)。结论 清黄颗粒具有较好的临床疗效,考虑应用于临床新生儿黄疸的治疗中,以促进患儿疾病的转归。

抗癌青黄汤、羟基脲片结合治疗慢性髓系白血病的疗效分析

目的观察对慢性髓系白血病患者使用抗癌青黄汤、羟基脲片治疗的效果。方法选取2021年3月—2023年5月本院收治的48例慢性髓系白血病患者为研究对象,并随机分为对照组和实验组,每组24例。其中,对照组采用羟基脲片治疗,实验组则采用羟基脲片+抗癌青黄汤治疗,对比两组治疗效果、安全性、血清学指标、症候变化分数。结果治疗前,两组骨髓中不成熟粒细胞水平、白细胞计数、症候变化对比,差异无统计学意义(P>0.05);治疗后,症候变化、骨髓中不成熟粒细胞水平、白细胞计数比较,实验组优于对照组,安全性、疗效比较,实验组优于对照组,差异有统计学意义(P<0.05)。结论慢性髓系白血病患者在接受羟基脲片联合抗癌青黄汤的综合治疗后,其病症控制效果及安全性得到了显著提升。该治疗方案有助于患者及早缓解各类不适症状,有效降低病情炎症因子水平,进而显著提高生存质量。

青黄散加补肾健脾中药治疗骨髓增生异常综合征的临床观察

目的观察青黄散加补肾健脾中药治疗骨髓增生异常综合征(MDS)的临床疗效。方法55例MDS患者给予青黄散、补肾健睥汤药及雄性激素等治疗。结果55例MDS患者中,完全缓解11例(20.0%),总有效41例(74.5%)。根据FAB分型,RA/RAS型34例,完全缓解9例(26.5%),总有效28例(82.4%);RAEB型21例,完全缓解2例(9.5%),总有效13例(61.9%),两型间疗效比较差异无统计学意义。按国际预后积分系统(IPSS)评定标准,中危Ⅰ组36例,有效25例(其中完全缓解10例),无效11例。中危Ⅱ组7例,完全缓解1例,有效4例,无效2例。高危组6例,完全缓解0例,有效3例,无效3例。3组疗效比较差异无统计学意义。有效者41例,治疗后白细胞、血红蛋白和血小板计数均较治疗前升高(P<0.05);染色体异常组16例,有效11例(68.8%);染色体正常组33例,有效24例(72.7%);染色体异常与否间疗效比较,差异无统计学意义。结论化瘀补肾为主综合治疗MDS具有确切的临床疗效,疗效与FAB分型、IPSS积分及染色体异常与否无明显相关性。

含砷中药复方青黄散治疗骨髓增生异常综合征的克隆选择性与砷体内效应的相关性研究

目的探讨含砷中药复方青黄散治疗骨髓增生异常综合征(MDS)的克隆选择性与砷体内效应的相关性。方法对接受口服青黄散(每日雄黄0.16 g)治疗的MDS患者40例(治疗组)进行疗效评价,分析MDS患者口服青黄散后血砷浓度和线粒体膜电位(△Ψm),并与未服用青黄散或其他砷制剂的MDS患者(未治疗组)以及正常人(健康对照组)进行比较。结果治疗组总有效率为75.0%(30/40)。伴随正常克隆与+8异常克隆患者的疗效明显好于其他异常克隆类型(P<0.05)。治疗组全血和血浆砷浓度均明显高于未治疗组及健康对照组(P<0.05)。治疗组有效患者的全血砷浓度明显高于治疗失败者(P<0.05)。治疗组全血砷浓度明显高于血浆砷浓度(P<0.05)。治疗组正常核型和+8患者与其他异常克隆患者的血砷浓度差异无统计学意义(P>0.05)。治疗组线粒体△Ψm与未治疗组比较差异无统计学意义(P>0.05)。治疗组线粒体△Ψm与全血砷浓度没有相关性(P>0.05)。结论口服青黄散治疗MDS,砷被人体少量吸收,并进入细胞内发挥作用。MDS患者对青黄散的治疗反应与全血砷浓度具有相关性。青黄散治疗MDS的克隆选择性与全血砷浓度以及线粒体△Ψm变化没有相关性。

麻柔教授病证结合治疗骨髓增生异常综合征浅谈

在中医学长期发展中,逐渐形成了病证结合的诊疗模式,这一模式适于发挥中西医双方优势,在临床诊疗中广泛应用。麻柔教授是中西医结合血液学专家,"参西而不背中",运用西医方法诊断疾病、中医方法治疗疾病的诊疗思路,在疾病诊疗过程中辨病与辨证相结合,根据骨髓增生异常综合征(myelodysplastic syndromes,MDS)的发病特点,认为此病本在"毒瘀",治以青黄散为主,解毒祛瘀,"去其所害";同时根据患者证候表现,总结出脾肾阳虚、肝肾阴虚两种常见证型,配合培补脾肾中药治疗,取得良好疗效。近年来临床研究与实验研究均取得一定成果,为进一步探讨麻柔教授病证结合治疗MDS学术思想提供了科学依据。

青黄散联合健脾补肾中药对骨髓增生异常综合征患者活化T细胞的影响

目的探讨青黄散联合健脾补肾中药对骨髓增生异常综合征(MDS)患者活化T细胞的影响。方法 24例MDS患者用青黄散联合健脾补肾中药治疗9个月前后,流式细胞仪检测外周血T细胞CD3+CD28+、CD3+CD28+CD4+CD8-、CD3+CD28+CD8+CD4-、CD3+CD25+、CD3+CD25+CD4+CD8-、CD3+CD25+CD8+CD4-、CD3+DR+、CD3+DR+CD4+CD8-、CD3+DR+CD8+CD4-的百分数与绝对值,分析有效组及无效组上述指标治疗前后的差异变化。结果有效组(13例)治疗后CD3+CD28+、CD3+CD28+CD4+CD8-、CD3+CD28+CD8+CD4-绝对值较治疗前明显下降(P<0.05),无效组(11例)此3项指标百分数也明显下降(P<0.05)。有效组治疗后CD3+CD25+、CD3+CD25+CD4+CD8-百分数与绝对值较治疗前明显下降(P<0.05),无效组此2项指标治疗前后比较差异均无统计学意义(P>0.05)。结论青黄散联合健脾补肾中药可通过降低MDS患者体内共刺激分子的表达引起T细胞第二信号缺失使T细胞处于失能状态,减少T细胞(特别是Th)细胞的活化,使MDS亢进的免疫状态得以抑制,避免正常造血细胞受到免疫攻击而致凋亡。

青黄散治疗骨髓增生异常综合征31例临床观察

目的:系统观察中药青黄散治疗骨髓增生异常综合征(MDS)的临床疗效。方法:采用随机对照方法。61例MDS患者随机分为治疗组(青黄散组)31例和对照组(维甲酸组)30例。3个月为1个疗程。结果:青黄散组总缓解率与总有效率分别为9.7%和74.1%,维甲酸组总缓解率与总有效率分别为0与46.7%,青黄散组疗效优于维甲酸组。青黄散毒副作用主要为皮肤色素沉着、角化过度及消化道症状。结论:中药青黄散治疗MDS有确切的临床疗效,能够明显改善红系造血,提高血红蛋白含量,提高白细胞数量,明显提高患者的生活质量,且患者耐受性好,对西药无效的患者仍然有效。

复方青黄胶囊治疗慢性粒细胞白血病6例临床报道

目的:研究复方青黄胶囊对慢性粒细胞白血病的临床疗效。方法:采用青黛、雄黄等制备成中药复方胶囊,进行临床慢性粒细胞白血病志愿者服药治疗研究,观察复方青黄胶囊对患者治疗前后血象及对预后和生存的影响。结果:6例患者均获得完整的随访资料,接受复方青黄胶囊治疗的慢性粒细胞白血病患者4例完全缓解,2例部分缓解;6例患者均未出现急性病变,1例已存活16年。结论:复方青黄胶囊对慢性粒细胞白血病有较好治疗效果,且副作用少,为中药砷剂治疗慢性粒细胞白血病提供了临床参考。

以雄黄为主方案治疗骨髓增生异常综合征伴多系病态造血患者的远期疗效

目的:观察雄黄为主方案治疗骨髓增生异常综合征伴多系病态造血(MDS-MLD)患者的远期疗效。方法:选取2007年8月至2015年4月中国中医科学院西苑医院收治的MDS-MLD患者130例作为研究对象并进行回顾性分析,给予青黄散(雄黄、青黛)、健脾补肾汤药,治疗36个月及以上,以患者治疗前后外周血中性粒细胞(ANC)、血红蛋白(Hb)、血小板(PLT)为观察指标,评价治疗前后血液学改善情况,并比较不同遗传学分型疗效。结果:130例患者完全缓解、血液学进步、稳定、疾病进展分别为18例(13.84%)、80例(61.54%)、24例(18.46%)、8例(6.15%);130例患者治疗前后外周血细胞ANC、Hb及PLT计数差异有统计学意义(P<0.05);外周血三系血细胞疗效比较,Hb与ANC、Hb与PLT血液学改善程度差异有统计学意义(P<0.01),而ANC与PLT血液学改善程度差异无统计学意义(P>0.05);不同遗传学分型血液学改善程度比较,差异无统计学意义(P>0.05)。结论:以雄黄为主方案能改善MDS-MLD外周血象,对红系改善更为明显。