急性白血病中西医结合治疗体会及典型病例分析

发布时间：2018-01-31 12:02

本文关键词： 急性白血病化疗中医药治疗　出处：《湖北中医学院》2008年硕士论文　论文类型：学位论文

【摘要】： 急性白血病(Acute leukemia,AL)是原发于造血组织的恶性增生性疾病,病变主要侵及骨髓、肝、脾、淋巴结,亦可累及其它器官。临床上往往以高热,进行性贫血,显著出血倾向或全身疼痛为首发症状,治疗不及时常常会很快死亡。急性白血病为现代医学名词,祖国医学中无此病名,但从其临床证见:起病急、发热、出血、贫血、肝脾淋巴结肿大等,颇与现代医学中急性白血病相似,属于祖国医学中急劳、血证、徵积、温邪等范畴。急性白血病的发病或因素体阴虚内热,或外感热毒所致,另和先天禀赋、劳役过度、情志、饮食、环境等因素有关,其他如家族遗传、胎中失养、接触大量放射线或苯、长期服用氯霉素等化学药品,都可引起本病。因此,中医对其病因、病机的认识主要是机体正气不足,感受毒邪,邪毒内蕴,伤及营血,骨髓受损,引起瘀血(临床表现为骨痛、肝脾肿大、舌质紫暗等)。血不循经,迫血妄行又发生各种出血征象。瘀血不去新血不生,故可见贫血血虚之证。血为气之母,在血虚基础上可致气虚,进一步发展可为阴阳两竭。本病治疗后,毒邪由盛转衰,正气渐复,病情可达缓解至治愈,而毒邪未尽,正气内虚时常有复发。迄今为止,联合化疗仍为治疗急性白血病的基础。但急性白血病化疗存在很多问题。首先,复发率高;其次,化疗过程中所致的胃肠道反应、肝肾功能损害、脱发、心脏毒性,易产生耐药性或对化疗药物不敏感;第三,化疗后骨髓及免疫功能抑制明显,并发症严重,患者生存质量显著下降。这不仅降低了患者化疗期间的生活质量,动摇了进一步治疗的信心,而且增加了治疗的难度,使患者的后期治疗阶段的治疗难以顺利进行。因此,亟待寻找新的治疗措施和手段,减缓化疗的毒副作用,提高患者生活质量,增强患者进一步治疗的信心。目前对于急性白血病的治疗,采用西药联合化疗为主,配合中医药进行调治,是被患者及家属普遍接受的一种治疗模式。但关键在于把握化疗的“度”。因为化疗药属剧毒药,应遵循“大毒治病”,“衰其大半”可也。上海中医药大学的吴翰香教授认为,化学药品有剧毒,其毒性远胜于砒、汞,因此,化疗不能诛伐太过,应当适可而止。化疗过量,非但无益,反而有害。中药配合化疗治疗急性白血病在多方面显示了优势。①能够保护骨髓功能,促进正常造血,如益气养阴中药和益气养血中药。②与化疗药物协同杀灭瘤细胞,如清热解毒、活血化瘀中药均具有不同程度的抑制白血病细胞的作用,增强化疗药物的杀伤白血病细胞的作用。③减轻化疗过程中的毒性反应,使患者能够接受并完成化疗,缩短骨髓抑制期,增强免疫功能。补益类、清热解毒类中药许多都具有调节机体免疫机制、增强免疫功能的作用。④由于体内微小残留白血病细胞的存在导致了急性白血病的复发,所以在急性白血病病人达到缓解以后需清热解毒中药、益气养阴中药配合化疗杀灭微小残留白血病细胞,增强患者的抵抗能力。急性白血病的化疗是有必要的,但要适可而止。积极开展中西医结合治疗,中医辨证施治与化疗并用比单用化疗疗效明显提高,同时可减轻化疗药物的毒副作用,提高缓解率,延长生存期,提高病人的生存质量,预防复发,部分病人可达治愈。
[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.

【学位授予单位】：湖北中医学院
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R733.71

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