本文關(guān)鍵詞： 急性髓系白血病 中醫(yī)證型 血清25(OH)D水平 危險分層　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:急性髓系白血病是常見的血液系統(tǒng)惡性腫瘤,細(xì)胞和分子遺傳學(xué)異常在急性髓系白血病發(fā)病機制中的作用被逐漸闡明。近年來的研究發(fā)現(xiàn),維生素D具有抗白血病作用,通過細(xì)胞信號傳導(dǎo)通路影響細(xì)胞生長、增殖,對白血病細(xì)胞有抗增殖及誘導(dǎo)分化的作用,影響疾病的發(fā)生發(fā)展。中醫(yī)認(rèn)為急性白血病屬"虛勞"范疇,"正虛邪盛"是急性白血病的主要病機,尤其是腎虛,而腎虛與機體精微物質(zhì)不足互為因果,進(jìn)一步損傷機體正氣,影響急性白血病的預(yù)后。祖國醫(yī)學(xué)認(rèn)為維生素D屬機體精微物質(zhì),本實驗即是探究急性髓系白血病的中醫(yī)證型分布與患者血清25(OH)D水平及疾病危險分層的關(guān)系,以期為急性髓系白血病的治療提供一個新的參考方向。方法:按實驗要求收集廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院血液科2016年4月至2017年1月的30例初診的急性髓系白血病患者,收集患者疾病初診時的四診資料,仔細(xì)辯證,確定患者的中醫(yī)證型,將患者分為熱毒熾盛證、脾腎陽虛證、氣血兩虛證、陰虛火旺證四種證型;并完善相關(guān)實驗室檢查,包括:①血常規(guī)、生化、凝血功能等;②骨髓細(xì)胞形態(tài)學(xué)檢測(包括鏡下細(xì)胞形態(tài)及免疫組化檢查);③細(xì)胞遺傳學(xué)(染色體檢查);④分子學(xué)檢測(AML相關(guān)的基因突變);⑤骨髓細(xì)胞流式檢查(免疫分型),然后綜合上述檢查結(jié)果,對初診的AML患者進(jìn)行危險分層;再按實驗要求檢測患者初診化療前和第一次化療后的血清25(OH)D水平。收集上述實驗數(shù)據(jù),采用SPSS 22.0軟件進(jìn)行統(tǒng)計,分別探討急性髓系白血病的中醫(yī)證型與患者血清25(OH)D水平及疾病的危險分層的關(guān)系、疾病危險分層與血清25(OH)D水平的關(guān)系,并觀察治療前后血清25(OH)D水平的變化。結(jié)果:1.急性髓系白血病患者血清25(OH)D 水平低于正常人群平均水平,差異具有統(tǒng)計學(xué)意義(P0.05)。2.急性髓系白血病的不同中醫(yī)證型的血清25(OH)D水平具有明顯差異(P0.05),脾腎陽虛證者血清25(OH)D水平以缺乏狀態(tài)為主;邪熱熾盛證、氣血兩虛證及陰虛火旺證者血清25(OH)D水平以不足狀態(tài)為主;鮮少患者可達(dá)理想水平,邪熱熾盛證者血清25(OH)D水平達(dá)理想狀態(tài)者較多。3.急性髓系白血病各危險分層的血清25(OH)D水平具有明顯差異(P0.05),高危組患者血清25(OH)D 水平以缺乏狀態(tài)為主;低危組及中危組血清25(OH)D水平以不足狀態(tài)為主。4.急性髓系白血病的不同中醫(yī)證型與疾病的危險分層具有相關(guān)性(P0.05),脾腎陽虛證者以高危組為主;氣血兩虛證者以中危組為主;熱毒熾盛證者低、中危組各半;陰虛火旺證者中、高危組各半。5.急性髓系白血病患者經(jīng)化療1程后復(fù)查血清25(OH)D水平較化療前升高,差異具有統(tǒng)計學(xué)意義(P0.05)。6.急性髓系白血病患者化療1程后復(fù)查血清25(OH)D水平與正常人均水平對比,差異沒有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1.急性髓系白血病的中醫(yī)證型與患者血清25(OH)D 水平具有相關(guān)性,脾腎陽虛證者血清25(OH)D水平最低。2.急性髓系白血病危險分層與患者血清25(OH)D水平具有相關(guān)性,血清25(OH)D水平越低,預(yù)后越差。3.急性髓系白血病的中醫(yī)證型與疾病預(yù)后分層具有相關(guān)性,脾腎陽虛證者預(yù)后最差。
[Abstract]:Objective: acute myeloid leukemia is a malignant tumor of blood system diseases, the role of cellular and molecular cytogenetic abnormalities in the pathogenesis of acute myeloid leukemia has been elucidated. Recent studies have found that vitamin D has anti leukemia effect, through cell signaling pathway effects on cell growth, proliferation, anti proliferation and differentiation the role of leukemia cells, influence the development of diseases. Traditional Chinese medicine believes that acute leukemia belongs to the category of "consumptive disease", "positive imaginary evil Sheng" is the main pathogenesis of acute leukemia, especially kidney deficiency, kidney deficiency and deficiency of body substances and further damage the body upright, reciprocal causation, influence the prognosis of acute leukemia. The motherland medicine thought vitamin D is a subtle body material, this experiment is to explore the acute myeloid leukemia distribution of TCM syndromes and serum 25 (OH) D levels and disease risk stratification, In order to provide a new reference for the treatment of acute myeloid leukemia. Methods: 30 cases of newly diagnosed acute myeloid collected from Department of Hematology in First Affiliated Hospital of Guangzhou University of Chinese Medicine from April 2016 to January 2017 according to the requirements of the AML patients, four patients with newly diagnosed disease diagnosis data collected when carefully determine the dialectical, TCM syndrome type of patients, the patients divided into heat toxin syndrome, Yang deficiency of spleen and kidney, deficiency of Qi and blood two, hyperactivity of fire due to yin deficiency syndrome type four; and improve the related laboratory tests, including: blood routine, biochemical, blood coagulation function; the morphological detection of bone marrow cells (including microscopic cell morphology and immunohistochemical examination); cell genetics (chromosome the molecular detection (AML); related gene mutation; 5) bone marrow cells flow cytometry examination (immunotype), then the examination results of the risk stratification of patients with newly diagnosed AML by experiment; The detection requirements of newly diagnosed patients with chemotherapy before and after the first chemotherapy treatment serum 25 (OH) D level. The collected experimental data, statistics using the SPSS 22 software, respectively explore the TCM syndrome type and serum of patients with acute myeloid leukemia (OH) 25, D level and the risk stratification of disease, disease and risk stratification serum 25 (OH) D levels were observed before and after treatment, serum D levels of 25 (OH). Results: 1. patients with acute myeloid leukemia 25 (OH) D level is lower than the average level of the normal population, the difference was statistically significant (P0.05) in different TCM Syndromes of.2. acute myeloid leukemia. Serum 25 (OH) D level with a significant difference (P0.05), spleen kidney yang deficiency syndrome serum 25 (OH) D level by a lack of state; pathogenic heat syndrome, Qi deficiency and Yin Deficiency Hyperactivity of fire two serum 25 (OH) D levels in shortage; few patients up to the ideal level of evil heat Syndrome of serum 25 (OH) D levels up to the ideal state of more.3. of acute myeloid leukemia in the risk stratification of serum 25 (OH) D level with a significant difference (P0.05), a high-risk group of patients serum 25 (OH) D level by a lack of state; the low risk group and risk group serum 25 (OH) associated with risk stratification in different TCM Syndromes of D and disease level to shortage of.4. in acute myeloid leukemia (P0.05), the spleen kidney yang deficiency syndrome in high risk group; two in blood deficiency in the risk group; reduchishen card in low risk group were; Yin Huo Wang card in the high-risk groups of.5. patients with acute myeloid leukemia after chemotherapy in 1 after the process of review of serum 25 (OH) D levels than before treatment increased, the difference was statistically significant (P0.05.6.) in acute myeloid leukemia patients undergoing chemotherapy after 1 months serum 25 (OH) D level and normal water level per capita compared, the difference was not statistically (meaning P0.05). Conclusion: 1. acute myeloid leukemia patients with TCM syndrome and serum 25 (OH) associated with D levels, spleen kidney yang deficiency syndrome serum 25 (OH) D the lowest level of.2. in acute myeloid leukemia risk stratification and serum 25 (OH) associated with the level of D, serum 25 (OH) D the lower the level, with the correlation between TCM syndrome types of.3. prognosis of acute myeloid leukemia and disease prognosis of spleen kidney yang deficiency syndrome are the worst prognosis.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733.71

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本文編號：1509359