發(fā)布時間：2018-04-22 19:33

  本文選題：桃紅四物湯 + VP方案��； 參考：《中華中醫(yī)藥學刊》2017年04期

【摘要】：目的:研究桃紅四物湯加減聯(lián)合VP方案治療難治性多發(fā)性骨髓瘤(MM)臨床療效。方法:將醫(yī)院血液科41例復發(fā)/難治性多發(fā)性骨髓瘤患者納入研究樣本,以隨機數(shù)表法分為觀察組(21例)和對照組(20例),對照組給予VP方案(V:注射用硼替佐米,P:地塞米松)干預,V:1.3 mg/m~2推注,于1、4、8、11 d給藥,21 d/療程;P:15 mg靜注,1、2、4、5、8、9、11、12 d給藥。觀察組另給予桃紅四物湯加減干預,2療程后比較兩組西醫(yī)療效、中醫(yī)證候療效,并比較兩組治療前后直接病理指標(破骨細胞、成骨細胞、漿細胞比率)及間接病理指標(中性粒細胞、血小板計數(shù)、血沉、血尿素氮、血鈣、血紅蛋白)的差異,以分析中西聯(lián)合治療的療效及桃紅四物湯可能的治療機制。結果:觀察組西醫(yī)有效率、中醫(yī)證候總有效率均為90.47%,與對照組65%、55%比較顯著較高(P0.05)。觀察組治療后破骨細胞及漿細胞比率分別為(0.17±0.05)個/mm~2、(4.69±2.06)%與對照組及治療前比較顯著較低(P0.05),觀察組成骨細胞治療后為(1.31±0.42)個/mm~2與對照組比較顯著較高(P0.05);觀察組治療后中性粒細胞、血小板計數(shù)、血紅蛋白分別為(2.79±1.02)×10~9/L、(42.16±9.15)×10~9/L、(91.74±11.32)g/L與對照組比較顯著較高(P0.05),兩組血沉、血鈣、血尿素氮治療后比較均無統(tǒng)計學意義(P0.05);觀察組總不良反應發(fā)生率42.86%與對照組65%比較較低,但差異無統(tǒng)計意義(P0.05)。結論:桃紅四物湯加減聯(lián)合西藥治療難治性多發(fā)性骨髓瘤具有顯著增效作用,其機制可能與方內(nèi)多味活血藥物可提高血小板、血紅蛋白以及白細胞水平相關,同時可減少化療不良反應,遠期療效及對復發(fā)的控制有待進一步研究。
[Abstract]:Objective: to study the clinical effect of Taohong Siwu decoction combined with VP regimen in the treatment of refractory multiple myeloma. Methods: 41 patients with recurrent / refractory multiple myeloma were included in the study. The control group (n = 20) was divided into observation group (n = 21) and control group (n = 20). The control group was treated with VP regimen: bortezomide: dexamethasone). The control group was given V1: 1. 3 mg/m~2 injection. The observation group was treated with Taohong Siwu decoction in addition and subtraction. After two courses of treatment, the curative effect of western medicine and TCM syndrome were compared, and the direct pathological indexes (osteoclast, osteoblast) were compared before and after treatment. The difference of plasma cell ratio and indirect pathological indexes (neutrophil, platelet count, erythrocyte sedimentation rate, blood urea nitrogen, blood calcium, hemoglobin) was used to analyze the therapeutic effect of combined Chinese and Western treatment and the possible therapeutic mechanism of Taohong Siwu decoction. Results: the effective rate of western medicine and the total effective rate of TCM syndromes in the observation group were all 90.47, which were significantly higher than those in the control group (65%, 55%). After treatment, the ratio of osteoclasts and plasma cells in the observation group was 0.17 鹵0.05). The ratio of osteoclasts and plasma cells in the observation group was 4.69 鹵2.06%, which was significantly lower than that in the control group and before treatment. The platelet count, hemoglobin were 2.79 鹵1.02 脳 10 ~ (9 / L) L ~ (-1) (42.16 鹵9.15) 脳 10 ~ (9) / L ~ (-1) 鹵10 ~ (-9) / L ~ (-1) 鹵91.74 鹵11.32)g/L were significantly higher than those in the control group (P < 0.05). There was no significant difference in blood sedimentation rate, blood calcium and blood urea nitrogen between the two groups (P _ (0.05)), the incidence of total adverse reactions in the observation group was 42.86% compared with that in the control group (65%). But the difference was not statistically significant (P 0.05). Conclusion: Taohong Siwu decoction combined with western medicine has a significant synergistic effect in the treatment of refractory multiple myeloma, and its mechanism may be related to the increase of platelet, hemoglobin and white blood cell levels. At the same time, it can reduce the adverse reaction of chemotherapy. The long-term effect and the control of recurrence need further study.
【作者單位】： 杭州市第二人民醫(yī)院腫瘤血液科;杭州市下城區(qū)中醫(yī)院康復病區(qū);
【基金】：杭州市衛(wèi)生科技計劃(A類)項目(2011A016)
【分類號】：R733.3

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