急性髓系白血病中医证型分布与血清25（OH）D的相关性研究

发布时间：2018-02-13 23:35

本文关键词： 急性髓系白血病中医证型血清25(OH)D水平危险分层　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:急性髓系白血病是常见的血液系统恶性肿瘤,细胞和分子遗传学异常在急性髓系白血病发病机制中的作用被逐渐阐明。近年来的研究发现,维生素D具有抗白血病作用,通过细胞信号传导通路影响细胞生长、增殖,对白血病细胞有抗增殖及诱导分化的作用,影响疾病的发生发展。中医认为急性白血病属"虚劳"范畴,"正虚邪盛"是急性白血病的主要病机,尤其是肾虚,而肾虚与机体精微物质不足互为因果,进一步损伤机体正气,影响急性白血病的预后。祖国医学认为维生素D属机体精微物质,本实验即是探究急性髓系白血病的中医证型分布与患者血清25(OH)D水平及疾病危险分层的关系,以期为急性髓系白血病的治疗提供一个新的参考方向。方法:按实验要求收集广州中医药大学第一附属医院血液科2016年4月至2017年1月的30例初诊的急性髓系白血病患者,收集患者疾病初诊时的四诊资料,仔细辩证,确定患者的中医证型,将患者分为热毒炽盛证、脾肾阳虚证、气血两虚证、阴虚火旺证四种证型;并完善相关实验室检查,包括:①血常规、生化、凝血功能等;②骨髓细胞形态学检测(包括镜下细胞形态及免疫组化检查);③细胞遗传学(染色体检查);④分子学检测(AML相关的基因突变);⑤骨髓细胞流式检查(免疫分型),然后综合上述检查结果,对初诊的AML患者进行危险分层;再按实验要求检测患者初诊化疗前和第一次化疗后的血清25(OH)D水平。收集上述实验数据,采用SPSS 22.0软件进行统计,分别探讨急性髓系白血病的中医证型与患者血清25(OH)D水平及疾病的危险分层的关系、疾病危险分层与血清25(OH)D水平的关系,并观察治疗前后血清25(OH)D水平的变化。结果: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,差异具有统计学意义(P0.05)。2.急性髓系白血病的不同中医证型的血清25(OH)D水平具有明显差异(P0.05),脾肾阳虚证者血清25(OH)D水平以缺乏状态为主;邪热炽盛证、气血两虚证及阴虚火旺证者血清25(OH)D水平以不足状态为主;鲜少患者可达理想水平,邪热炽盛证者血清25(OH)D水平达理想状态者较多。3.急性髓系白血病各危险分层的血清25(OH)D水平具有明显差异(P0.05),高危组患者血清25(OH)D 水平以缺乏状态为主;低危组及中危组血清25(OH)D水平以不足状态为主。4.急性髓系白血病的不同中医证型与疾病的危险分层具有相关性(P0.05),脾肾阳虚证者以高危组为主;气血两虚证者以中危组为主;热毒炽盛证者低、中危组各半;阴虚火旺证者中、高危组各半。5.急性髓系白血病患者经化疗1程后复查血清25(OH)D水平较化疗前升高,差异具有统计学意义(P0.05)。6.急性髓系白血病患者化疗1程后复查血清25(OH)D水平与正常人均水平对比,差异没有统计学意义(P0.05)。结论:1.急性髓系白血病的中医证型与患者血清25(OH)D 水平具有相关性,脾肾阳虚证者血清25(OH)D水平最低。2.急性髓系白血病危险分层与患者血清25(OH)D水平具有相关性,血清25(OH)D水平越低,预后越差。3.急性髓系白血病的中医证型与疾病预后分层具有相关性,脾肾阳虚证者预后最差。
[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.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71

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