多发性骨髓瘤肿瘤负荷与证型及疗效分析

发布时间：2018-04-10 03:38

本文选题：多发性骨髓瘤　切入点：中医证型　出处：《广州中医药大学》2016年硕士论文

【摘要】：目的：通过研究初诊多发性骨髓瘤(MM)患者不同的Greipp分型与不同中医证型关系,并观察中西医结合治疗对多发性骨髓瘤各证型疗效,为中医对多发性骨髓瘤进行整体辨证论治结合西医治疗提供疗效分析参考。方法：对广州中医药大学第一附属医院2007年1月--2016年1月期间住院收治初诊多发性骨髓瘤病人64例进行回顾性研究,根据《广州中医药大学第一附属医院血液科多发性骨髓瘤优势病种诊疗规范》将患者分为痰瘀痹阻证、肝肾亏虚证、气血亏虚证、脾肾阳衰证四种证型,并按治疗方法分为万珂组及非万珂组,通过对患者初诊骨髓涂片进行显微镜复片,确定Greipp分型。运用SPSS19.0软件对数据进行统计学分析,观察各组患者治疗前后的血β2-微球蛋白(β 2-MG)、骨髓瘤细胞(Myeloma cell, MC)比例改变和中医症候疗效,并观察治疗前不同中医证型与血β2-微球蛋白、骨髓瘤细胞比例及Greipp分型的关系。结果：1.初诊多发性骨髓瘤各证型的Greipp分型有明显差异(P0.05),痰瘀痹阻证以成熟型骨髓瘤为主,肝肾亏虚证以中间型骨髓瘤为主,气血亏虚证以原始型骨髓瘤为主,而脾肾阳衰证未见到成熟型骨髓瘤。2.初诊多发性骨髓瘤各中医证型β2-MG、骨髓瘤细胞比例无明显差异(P0.05)。3.第一次及第四次中西医结合治疗后,万珂组及非万珂组中各中医证型中β 2-MG水平、骨髓瘤细胞比例、中医症候积分较化疗前皆有显著下降(均P0.05)。化疗后,血β2-MG水平、骨髓瘤细胞比例,痰瘀痹阻证下降最明显(P0.05)。各证型中,痰瘀痹阻证的中医疗效最显著(P0.05)。结论：1.多发性骨髓瘤Greipp分型与中医证型具有相关性,血β2-MG水平及骨髓瘤细胞比例与中医证型没有相关性。2.多发性骨髓瘤痰瘀痹阻证患者治疗后肿瘤负荷指标血β 2-MG水平及骨髓瘤细胞比例下降水平与中医疗效最佳。
[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.
【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】：2016
【分类号】：R733.3

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