本文關(guān)鍵詞： 急性白血病 化療 中醫(yī)藥治療　出處：《湖北中醫(yī)學(xué)院》2008年碩士論文　論文類型：學(xué)位論文

【摘要】： 急性白血病(Acute leukemia,AL)是原發(fā)于造血組織的惡性增生性疾病,病變主要侵及骨髓、肝、脾、淋巴結(jié),亦可累及其它器官。臨床上往往以高熱,進(jìn)行性貧血,顯著出血傾向或全身疼痛為首發(fā)癥狀,治療不及時(shí)常常會很快死亡。急性白血病為現(xiàn)代醫(yī)學(xué)名詞,祖國醫(yī)學(xué)中無此病名,但從其臨床證見:起病急、發(fā)熱、出血、貧血、肝脾淋巴結(jié)腫大等,頗與現(xiàn)代醫(yī)學(xué)中急性白血病相似,屬于祖國醫(yī)學(xué)中急勞、血證、徵積、溫邪等范疇。急性白血病的發(fā)病或因素體陰虛內(nèi)熱,或外感熱毒所致,另和先天稟賦、勞役過度、情志、飲食、環(huán)境等因素有關(guān),其他如家族遺傳、胎中失養(yǎng)、接觸大量放射線或苯、長期服用氯霉素等化學(xué)藥品,都可引起本病。因此,中醫(yī)對其病因、病機(jī)的認(rèn)識主要是機(jī)體正氣不足,感受毒邪,邪毒內(nèi)蘊(yùn),傷及營血,骨髓受損,引起瘀血(臨床表現(xiàn)為骨痛、肝脾腫大、舌質(zhì)紫暗等)。血不循經(jīng),迫血妄行又發(fā)生各種出血征象。瘀血不去新血不生,故可見貧血血虛之證。血為氣之母,在血虛基礎(chǔ)上可致氣虛,進(jìn)一步發(fā)展可為陰陽兩竭。本病治療后,毒邪由盛轉(zhuǎn)衰,正氣漸復(fù),病情可達(dá)緩解至治愈,而毒邪未盡,正氣內(nèi)虛時(shí)常有復(fù)發(fā)。 迄今為止,聯(lián)合化療仍為治療急性白血病的基礎(chǔ)。但急性白血病化療存在很多問題。首先,復(fù)發(fā)率高;其次,化療過程中所致的胃腸道反應(yīng)、肝腎功能損害、脫發(fā)、心臟毒性,易產(chǎn)生耐藥性或?qū)熕幬锊幻舾?第三,化療后骨髓及免疫功能抑制明顯,并發(fā)癥嚴(yán)重,患者生存質(zhì)量顯著下降。這不僅降低了患者化療期間的生活質(zhì)量,動搖了進(jìn)一步治療的信心,而且增加了治療的難度,使患者的后期治療階段的治療難以順利進(jìn)行。因此,亟待尋找新的治療措施和手段,減緩化療的毒副作用,提高患者生活質(zhì)量,增強(qiáng)患者進(jìn)一步治療的信心。目前對于急性白血病的治療,采用西藥聯(lián)合化療為主,配合中醫(yī)藥進(jìn)行調(diào)治,是被患者及家屬普遍接受的一種治療模式。但關(guān)鍵在于把握化療的“度”。因?yàn)榛熕帉賱《舅?應(yīng)遵循“大毒治病”,“衰其大半”可也。上海中醫(yī)藥大學(xué)的吳翰香教授認(rèn)為,化學(xué)藥品有劇毒,其毒性遠(yuǎn)勝于砒、汞,因此,化療不能誅伐太過,應(yīng)當(dāng)適可而止�；熯^量,非但無益,反而有害。 中藥配合化療治療急性白血病在多方面顯示了優(yōu)勢。①能夠保護(hù)骨髓功能,促進(jìn)正常造血,如益氣養(yǎng)陰中藥和益氣養(yǎng)血中藥。②與化療藥物協(xié)同殺滅瘤細(xì)胞,如清熱解毒、活血化瘀中藥均具有不同程度的抑制白血病細(xì)胞的作用,增強(qiáng)化療藥物的殺傷白血病細(xì)胞的作用。③減輕化療過程中的毒性反應(yīng),使患者能夠接受并完成化療,縮短骨髓抑制期,增強(qiáng)免疫功能。補(bǔ)益類、清熱解毒類中藥許多都具有調(diào)節(jié)機(jī)體免疫機(jī)制、增強(qiáng)免疫功能的作用。④由于體內(nèi)微小殘留白血病細(xì)胞的存在導(dǎo)致了急性白血病的復(fù)發(fā),所以在急性白血病病人達(dá)到緩解以后需清熱解毒中藥、益氣養(yǎng)陰中藥配合化療殺滅微小殘留白血病細(xì)胞,增強(qiáng)患者的抵抗能力。 急性白血病的化療是有必要的,但要適可而止。積極開展中西醫(yī)結(jié)合治療,中醫(yī)辨證施治與化療并用比單用化療療效明顯提高,同時(shí)可減輕化療藥物的毒副作用,提高緩解率,延長生存期,提高病人的生存質(zhì)量,預(yù)防復(fù)發(fā),部分病人可達(dá)治愈。
[Abstract]:Acute leukemia (Acute leukemia AL) is a malignant hyperplasia disease of primary hematopoietic tissue in the main invasion and bone marrow lesions, liver, spleen, lymph nodes, can also affect other organs. The clinical often by high fever, anemia, bleeding tendency or significant systemic pain as the first symptom, the treatment is not timely very often fast death. Acute leukemia is the modern medical terminology, Chinese medicine without the disease, but its clinical manifestations can be seen: acute onset, fever, bleeding, anemia, hepatosplenomegaly and lymphadenopathy, and acute leukemia in modern medicine is quite similar, which belongs to the urgent work, Chinese medicine syndrome, Zheng Ji, Wen Xie etc.. The incidence of acute leukemia or factors caused by Yin deficiency, or exogenous heat toxin, and other congenital, excessive labour, emotion, diet, environmental and other factors, such as other family, child custody in the loss, radiation or benzene exposure large, long-term use of chloramphenicol, etc. The chemical can cause the disease. Therefore, traditional Chinese medicine on the etiology, pathogenesis is mainly the understanding of the deficiency of vital qi, feelings of toxin, Xiedu connotation, hurt the business of blood, bone marrow damage caused by blood stasis (clinical manifestations of bone pain, hepatosplenomegaly, dark purple tongue). Blood Meridian, forced blood folly and various signs of bleeding. Blood stasis to new blood is not so visible, anemia syndrome. Blood and blood is the mother of Qi, blood deficiency can cause in the basis for the further development of Qi, yin and yang two exhausted. After the treatment of this disease, poison by Sheng Zhuanshuai, gradually re righteousness, the condition can be achieved remission to cure, but not poison, Qi deficiency often relapse.
So far, still based combined chemotherapy in the treatment of acute leukemia chemotherapy of acute leukemia. But there are many problems. First, the recurrence rate is high; secondly, gastrointestinal reactions induced by chemotherapy in the process of liver and kidney damage, alopecia, cardiac toxicity, drug resistance or not sensitive to chemotherapy drugs; third, after chemotherapy and bone marrow inhibit the immune function obviously, serious complications, quality of life of patients decreased significantly. This not only reduces the life quality of patients in chemotherapy, further shaken the confidence of treatment, but also increase the difficulty of treatment, the treatment of the treatment of late stage patients is smooth. Therefore, it is urgent to find new therapeutic measures and means, slow down the side effects of chemotherapy, improve the quality of life of patients, enhance the patient's confidence of further treatment. At present, for the treatment of acute leukemia, with western medicine combined with chemotherapy, combined with traditional Chinese Medicine For treating, is a kind of treatment mode is accepted by the patients and their families. But the key is to grasp the "degree" of chemotherapy. Because the drugs are highly toxic chemotherapy drugs should follow the "drug treatment", "bad most of its" principle. Shanghai University of Traditional Chinese Medicine professor Wu Hanxiang said, a highly toxic chemical, toxic than arsenic. Mercury, therefore, the chemotherapy does not punish cutting too, should not overdo sth.. Overdose of chemotherapy, not only useless, but harmful.
The treatment of acute leukemia shows advantages in many aspects of traditional Chinese medicine combined with chemotherapy. It can protect the bone marrow function, promote normal hematopoiesis, such as tonifying qi and nourishing yin and nourishing qi in traditional Chinese medicine. Coordination with the chemotherapy drugs to kill tumor cells, such as detoxification, Huoxue Huayu herbs have different degrees of inhibition of leukemia cells, enhance chemotherapy drugs killing leukemia cells. To reduce the toxicity of chemotherapy, so that patients can receive chemotherapy and completed, shortening the time for bone marrow suppression, enhance immune function. Tonic, febrifuge and detoxifying herbs have many immune mechanism, enhancing immune function. Because of the minimal residual leukemia cells led to the existence of recurrence of acute leukemia, so to alleviate the need Qingrejiedu Chinese medicine in acute leukemia patients with chemotherapy, Chinese medicine of Supplementing Qi and nourishing yin to kill micro Small residual leukemic cells enhance the patient's resistance.
Acute leukemia chemotherapy is necessary, but should not overdo sth.. Actively carry out the combined treatment of TCM and Western medicine, TCM treatment with chemotherapy than chemotherapy alone significantly improve the efficacy, reduce the side effects of chemotherapy drugs, improve the response rate and prolong survival time, improve the quality of patient survival, relapse prevention, some patients can cure.

【學(xué)位授予單位】：湖北中醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R733.71

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