桃红四物汤加减联合VP方案治疗难治性多发性骨髓瘤临床观察

发布时间：2018-04-22 19:33

本文选题：桃红四物汤 + VP方案　；参考：《中华中医药学刊》2017年04期

【摘要】：目的:研究桃红四物汤加减联合VP方案治疗难治性多发性骨髓瘤(MM)临床疗效。方法:将医院血液科41例复发/难治性多发性骨髓瘤患者纳入研究样本,以随机数表法分为观察组(21例)和对照组(20例),对照组给予VP方案(V:注射用硼替佐米,P:地塞米松)干预,V:1.3 mg/m~2推注,于1、4、8、11 d给药,21 d/疗程;P:15 mg静注,1、2、4、5、8、9、11、12 d给药。观察组另给予桃红四物汤加减干预,2疗程后比较两组西医疗效、中医证候疗效,并比较两组治疗前后直接病理指标(破骨细胞、成骨细胞、浆细胞比率)及间接病理指标(中性粒细胞、血小板计数、血沉、血尿素氮、血钙、血红蛋白)的差异,以分析中西联合治疗的疗效及桃红四物汤可能的治疗机制。结果:观察组西医有效率、中医证候总有效率均为90.47%,与对照组65%、55%比较显著较高(P0.05)。观察组治疗后破骨细胞及浆细胞比率分别为(0.17±0.05)个/mm~2、(4.69±2.06)%与对照组及治疗前比较显著较低(P0.05),观察组成骨细胞治疗后为(1.31±0.42)个/mm~2与对照组比较显著较高(P0.05);观察组治疗后中性粒细胞、血小板计数、血红蛋白分别为(2.79±1.02)×10~9/L、(42.16±9.15)×10~9/L、(91.74±11.32)g/L与对照组比较显著较高(P0.05),两组血沉、血钙、血尿素氮治疗后比较均无统计学意义(P0.05);观察组总不良反应发生率42.86%与对照组65%比较较低,但差异无统计意义(P0.05)。结论:桃红四物汤加减联合西药治疗难治性多发性骨髓瘤具有显著增效作用,其机制可能与方内多味活血药物可提高血小板、血红蛋白以及白细胞水平相关,同时可减少化疗不良反应,远期疗效及对复发的控制有待进一步研究。
[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 卤0.05). The ratio of osteoclasts and plasma cells in the observation group was 4.69 卤2.06%, which was significantly lower than that in the control group and before treatment. The platelet count, hemoglobin were 2.79 卤1.02 脳 10 ~ (9 / L) L ~ (-1) (42.16 卤9.15) 脳 10 ~ (9) / L ~ (-1) 卤10 ~ (-9) / L ~ (-1) 卤91.74 卤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.
【作者单位】：杭州市第二人民医院肿瘤血液科;杭州市下城区中医院康复病区;
【基金】：杭州市卫生科技计划(A类)项目(2011A016)
【分类号】：R733.3

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