本文選題：多發(fā)性骨髓瘤　切入點：中醫(yī)證型　出處：《廣州中醫(yī)藥大學》2016年碩士論文

【摘要】：目的：通過研究初診多發(fā)性骨髓瘤(MM)患者不同的Greipp分型與不同中醫(yī)證型關系,并觀察中西醫(yī)結(jié)合治療對多發(fā)性骨髓瘤各證型療效,為中醫(yī)對多發(fā)性骨髓瘤進行整體辨證論治結(jié)合西醫(yī)治療提供療效分析參考。方法：對廣州中醫(yī)藥大學第一附屬醫(yī)院2007年1月--2016年1月期間住院收治初診多發(fā)性骨髓瘤病人64例進行回顧性研究,根據(jù)《廣州中醫(yī)藥大學第一附屬醫(yī)院血液科多發(fā)性骨髓瘤優(yōu)勢病種診療規(guī)范》將患者分為痰瘀痹阻證、肝腎虧虛證、氣血虧虛證、脾腎陽衰證四種證型,并按治療方法分為萬珂組及非萬珂組,通過對患者初診骨髓涂片進行顯微鏡復片,確定Greipp分型。運用SPSS19.0軟件對數(shù)據(jù)進行統(tǒng)計學分析,觀察各組患者治療前后的血β2-微球蛋白(β 2-MG)、骨髓瘤細胞(Myeloma cell, MC)比例改變和中醫(yī)癥候療效,并觀察治療前不同中醫(yī)證型與血β2-微球蛋白、骨髓瘤細胞比例及Greipp分型的關系。結(jié)果：1.初診多發(fā)性骨髓瘤各證型的Greipp分型有明顯差異(P0.05),痰瘀痹阻證以成熟型骨髓瘤為主,肝腎虧虛證以中間型骨髓瘤為主,氣血虧虛證以原始型骨髓瘤為主,而脾腎陽衰證未見到成熟型骨髓瘤。2.初診多發(fā)性骨髓瘤各中醫(yī)證型β2-MG、骨髓瘤細胞比例無明顯差異(P0.05)。3.第一次及第四次中西醫(yī)結(jié)合治療后,萬珂組及非萬珂組中各中醫(yī)證型中β 2-MG水平、骨髓瘤細胞比例、中醫(yī)癥候積分較化療前皆有顯著下降(均P0.05)。化療后,血β2-MG水平、骨髓瘤細胞比例,痰瘀痹阻證下降最明顯(P0.05)。各證型中,痰瘀痹阻證的中醫(yī)療效最顯著(P0.05)。結(jié)論：1.多發(fā)性骨髓瘤Greipp分型與中醫(yī)證型具有相關性,血β2-MG水平及骨髓瘤細胞比例與中醫(yī)證型沒有相關性。2.多發(fā)性骨髓瘤痰瘀痹阻證患者治療后腫瘤負荷指標血β 2-MG水平及骨髓瘤細胞比例下降水平與中醫(yī)療效最佳。
[Abstract]:Objective: to study the relationship between different Greipp types and different TCM syndromes in newly diagnosed patients with multiple myeloma, and to observe the therapeutic effect of integrated traditional Chinese and western medicine on multiple myeloma syndrome types.To provide a reference for the treatment of multiple myeloma by syndrome differentiation combined with western medicine.Methods: a retrospective study was conducted on 64 newly diagnosed multiple myeloma patients in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine from January 2007 to January 2016.According to the criteria for diagnosis and treatment of multiple myeloma in the Department of Hematology of the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, the patients were divided into four types: phlegm and stasis obstruction syndrome, deficiency of liver and kidney syndrome, deficiency of qi and blood syndrome, spleen and kidney yang failure syndrome.The patients were divided into Wancke group and non-Wancke group according to the treatment method. The Greipp classification was determined by microscopical recombination of bone marrow smears.The data were statistically analyzed by SPSS19.0 software. The changes of serum 尾 2-MGG (尾 2-MGG) ratio and the curative effect of TCM syndrome were observed before and after treatment, and the different TCM syndromes and serum 尾 2-microglobulin were observed before and after treatment.The relationship between the proportion of myeloma cells and Greipp typing.The result is 1: 1.There were significant differences in Greipp typing among the syndrome types of multiple myeloma at first diagnosis (P 0.05). The syndrome of obstruction of phlegm and stasis was mainly mature myeloma, the deficiency of liver and kidney was intermediate myeloma, and the deficiency of qi and blood was primary myeloma.However, mature myeloma was not seen in the syndrome of spleen and kidney yang failure.There was no significant difference in the proportion of myeloma cells between 尾 _ 2-MG and 尾 _ 2-MG in various TCM syndromes of newly diagnosed multiple myeloma.After the first and fourth treatment, the levels of 尾 2-MG, the proportion of myeloma cells and the score of TCM symptom in Wancke group and non-Wancke group were significantly lower than those before chemotherapy (all P 0.05).After chemotherapy, the levels of serum 尾 2-MG, the proportion of myeloma cells and the syndrome of obstruction of phlegm and stasis were significantly decreased (P 0.05).Among the syndrome types, phlegm and stasis obstruction syndrome has the most significant curative effect of P0.05.Conclusion 1.Greipp classification of multiple myeloma was correlated with TCM syndrome type, but blood 尾 2-MG level and proportion of myeloma cells had no correlation with TCM syndrome type. 2.After treatment, the level of serum 尾 2-MG and the proportion of myeloma cells in patients with multiple myeloma due to phlegm and stasis obstruction were the best.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R733.3

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