沈一平中西医结合治疗老年急性髓系白血病经验拾萃
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摘要
[目的]总结沈一平主任中医师中西医结合治疗老年急性髓系白血病(acute myeloid leukemia,AML)的临床经验。[方法]通过跟诊、查房,收集沈师收治的老年AML患者病案,学习最新诊疗指南,阅读相关论文和相关古籍经典,从病因病机、治则治法等方面分析总结沈师中西医结合治疗老年AML的临床经验,并举验案佐证。[结果]沈师认为,老年AML病机多为虚实夹杂,患者先天禀赋不足、脾肾亏虚,热毒内侵,灼津为痰,痰瘀互结,邪蕴骨髓。沈师常用清热解毒药配合化疗,同时兼补益药益气扶正,达到治病而不伤正的目的,以"抗白延年汤"联合地西他滨+化疗为基础方案,并根据患者的临床表现、证型转变进行加减治疗,临床疗效显著。所举案例热毒内侵、痰瘀互结,在化疗的基础上配合清热解毒兼益气扶正治疗,获得较好的效果。[结论]沈师善于融合中西两法,辨证、辨病相结合,运用清热法联合补法治疗老年AML,值得推广学习。
[Objective]To summarize Dr. SHEN Yiping's clinical experience of integrated traditional Chinese and western medicine in treating elderly acute myeloid leukemia(AML). [Methods]By examining with cases of illness and warding round,collecting the medical records of elderly AML patients treated by Dr. SHEN, learning the latest diagnosis and treatment guidelines, reading a large number of related papers and a large number of classical books, from the aspects of etiology and pathogenesis, therapeutic principles and methods, the clinical experience of the treatment of elderly AML were analyzed and summarized, and one medical record was provided. [Results]Dr. SHEN believes that the pathogenesis is deficiency syndrome accompanied with excess syndrome. Mostly due to congenital deficiency and poor basic functions, deficiency of spleen and kidney, heat poison intrusion, burning Jin as sputum,forcing blood going in wrong line, phlegm and blood stasis, evil accumulating in bone marrow and then suffered. Dr. SHEN uses heat-clearing, detoxifying and anti-cancer drugs to suppress and eliminate leukemia cells on the basis of chemotherapy and supplements beneficial drugs to achieve the goal of chemotherapy without harming the positive effect, he uses"Kangbai Yannian Tang"combined with decitabine and chemotherapy as a basic solution and changes flexibly by according to the clinical manifestations, changes of syndrome types of the patients, the clinical effect is remarkable, and the case had good results. [Conclusion]Dr. SHEN is good at integrated traditional Chinese and western, combining of syndrome differentiation and disease differentiation, using the combination of heat-clearing method and complement in the treatment of elderly AML, the experience and wonderful methods are worth learning and spreading.
[Objective]To summarize Dr. SHEN Yiping's clinical experience of integrated traditional Chinese and western medicine in treating elderly acute myeloid leukemia(AML). [Methods]By examining with cases of illness and warding round,collecting the medical records of elderly AML patients treated by Dr. SHEN, learning the latest diagnosis and treatment guidelines, reading a large number of related papers and a large number of classical books, from the aspects of etiology and pathogenesis, therapeutic principles and methods, the clinical experience of the treatment of elderly AML were analyzed and summarized, and one medical record was provided. [Results]Dr. SHEN believes that the pathogenesis is deficiency syndrome accompanied with excess syndrome. Mostly due to congenital deficiency and poor basic functions, deficiency of spleen and kidney, heat poison intrusion, burning Jin as sputum,forcing blood going in wrong line, phlegm and blood stasis, evil accumulating in bone marrow and then suffered. Dr. SHEN uses heat-clearing, detoxifying and anti-cancer drugs to suppress and eliminate leukemia cells on the basis of chemotherapy and supplements beneficial drugs to achieve the goal of chemotherapy without harming the positive effect, he uses"Kangbai Yannian Tang"combined with decitabine and chemotherapy as a basic solution and changes flexibly by according to the clinical manifestations, changes of syndrome types of the patients, the clinical effect is remarkable, and the case had good results. [Conclusion]Dr. SHEN is good at integrated traditional Chinese and western, combining of syndrome differentiation and disease differentiation, using the combination of heat-clearing method and complement in the treatment of elderly AML, the experience and wonderful methods are worth learning and spreading.
引文
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[6]李沛,姜孝新,张秋桂.急性粒细胞白血病细胞逃避NK细胞杀伤机制的研究进展[J].肿瘤药学,2014,4(5):322-327.
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[8]高石磊.热休克蛋白90在急性髓系白血病患者血清中的表达及临床意义[D].石家庄:河北医科大学,2014:22.
[9]马新建,张付华,孙莉.PD-L1、HSP90及HSP90α在急性白血病患者中表达及其意义[J].中国实验血液学杂志,2017,25(5):1384-1389.
[10]李静,沈益民,林圣云,等.BIIB021对MDS细胞株Skm-1增殖的多靶点抑制作用研究[J].浙江医学,2017,39(8):599-600.
[11]李颖,旷文勇,李睿娟,等.热休克蛋白70及pim-1基因在白血病骨髓单个核细胞的表达特点及临床意义[J].中国实验血液学杂志,2008,16(2):267-271.
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[14]中华医学会血液学分会.成人急性髓系白血病(非急性早幼粒细胞白血病)中国诊疗指南(2011年版)[J].中华血液学杂志,2011,32(11):804-807.
[15]吴迪炯,叶宝东,沈建平,等.小剂量HA/HAA方案诱导治疗老年急性髓系白血病临床观察[J].中华血液学杂志,2014,35(3):256-259.
[16]俞庆宏,沈一平,叶宝东,等.小剂量HA方案治疗老年急性髓细胞性白血病临床观察[J].中国肿瘤,2014,23(5):435-437.
[17]王博,武利强,叶宝东,等.白花蛇舌草熊果酸诱导白血病耐药K562/ADM细胞凋亡及其作用机理的研究[J].中华中医药学刊,2013,31(4):921-924.
[18]张前杏,蔡文亮,颜平康,等.中医药治疗白血病研究进展[J].辽宁中医药大学学报,2015,17(9):110-113.
[19]Grimwade D,Walker H,Harrison G,et al.The predictive of 1 065 value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia(AML):analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial[J].Blood,2001,98(5):1312-1320.
[20]Grishina O,Schmoor C,Dhner K,et al.DECIDER:prospective randomized multicenter phaseⅡtrial of lowdose decitabine(DAC)administered alone or in combination with the histone deacetylase inhibitor valproic acid(VPA)and all-trans retinoic acid(ATRA)in patients>60years with acute my eloid leukemia who are ineligible for induction chemotherapy[J].BMC Cancer,2015,15(1):430.
[21]赵瑞,沈一平,翟斡.应用抗白延年汤辅助治疗老年急性白血病的经验[J].广西中医药大学学报,2013,16(3):13-14.
[2]余元勋,解毅,夏瑞祥,等.中国分子白血病学[M].合肥:安徽科学技术出版社,2016:141-151.
[3]Isidori A,Venditti A,Maurillo L,et al.Alternative novel therapies for the treatment of elderly acute myeloid leukemia patients[J].Expert Rev Hematol,2013,6(6):767-784.
[4]杨华,牛建花,朱成英,等.76例老年急性髓系AML(非APL)诱导化疗疗效及预后分析[J].中国实验血液学杂志,2014,22(4):957-964.
[5]Kerr J R,Mattey D L.The role of parvovirus B19 and the immune response in the pathogenesis of acute leukemia[J].Rev Med Virol,2015,25(3):133-155.
[6]李沛,姜孝新,张秋桂.急性粒细胞白血病细胞逃避NK细胞杀伤机制的研究进展[J].肿瘤药学,2014,4(5):322-327.
[7]Barrett A J,Le B K.Immunotherapy prospects for acute myeloid leukaemia[J].Clin Exp Immunol,2010,161(2):223-232.
[8]高石磊.热休克蛋白90在急性髓系白血病患者血清中的表达及临床意义[D].石家庄:河北医科大学,2014:22.
[9]马新建,张付华,孙莉.PD-L1、HSP90及HSP90α在急性白血病患者中表达及其意义[J].中国实验血液学杂志,2017,25(5):1384-1389.
[10]李静,沈益民,林圣云,等.BIIB021对MDS细胞株Skm-1增殖的多靶点抑制作用研究[J].浙江医学,2017,39(8):599-600.
[11]李颖,旷文勇,李睿娟,等.热休克蛋白70及pim-1基因在白血病骨髓单个核细胞的表达特点及临床意义[J].中国实验血液学杂志,2008,16(2):267-271.
[12]李用粹.证治汇补[M]太原:山西科学技术出版社,2011:57.
[13]Strickland S A,Shaver A C,Byrne M,et al.Genotypic and clinical heterogeneity within NCCN favorable-risk acute myeloid leukemia[J].Leuk Res,2018,65:67-73.
[14]中华医学会血液学分会.成人急性髓系白血病(非急性早幼粒细胞白血病)中国诊疗指南(2011年版)[J].中华血液学杂志,2011,32(11):804-807.
[15]吴迪炯,叶宝东,沈建平,等.小剂量HA/HAA方案诱导治疗老年急性髓系白血病临床观察[J].中华血液学杂志,2014,35(3):256-259.
[16]俞庆宏,沈一平,叶宝东,等.小剂量HA方案治疗老年急性髓细胞性白血病临床观察[J].中国肿瘤,2014,23(5):435-437.
[17]王博,武利强,叶宝东,等.白花蛇舌草熊果酸诱导白血病耐药K562/ADM细胞凋亡及其作用机理的研究[J].中华中医药学刊,2013,31(4):921-924.
[18]张前杏,蔡文亮,颜平康,等.中医药治疗白血病研究进展[J].辽宁中医药大学学报,2015,17(9):110-113.
[19]Grimwade D,Walker H,Harrison G,et al.The predictive of 1 065 value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia(AML):analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial[J].Blood,2001,98(5):1312-1320.
[20]Grishina O,Schmoor C,Dhner K,et al.DECIDER:prospective randomized multicenter phaseⅡtrial of lowdose decitabine(DAC)administered alone or in combination with the histone deacetylase inhibitor valproic acid(VPA)and all-trans retinoic acid(ATRA)in patients>60years with acute my eloid leukemia who are ineligible for induction chemotherapy[J].BMC Cancer,2015,15(1):430.
[21]赵瑞,沈一平,翟斡.应用抗白延年汤辅助治疗老年急性白血病的经验[J].广西中医药大学学报,2013,16(3):13-14.