冒湘琳 谌海燕 郭明 刘军霞 郎海燕 李玲 廖俊尧 廖婧 丁晓庆

摘要 目的：觀察中西医结合治疗骨髓增生异常综合征（Myelodysplastic Syndromes，MDS）的中位生存期，探究影响MDS患者生存期的因素。方法：选取2009年12月至2018年5月北京中医药大学东方医院收治的自愿接受益髓浓煎方联合西药治疗的MDS患者57例作为研究对象，随访至死亡或观察截止，记录其中医证型及血液、骨髓等检查，分析评估生存期的影响因素。结果：57例患者中位生存期30个月，其中65周岁以下较高危组患者中位生存期30个月，长于国内报道的27个月以下。8例接受地西他滨联合中药治疗的较高危组患者中位生存期17个月，长于文献报道的单纯西药治疗的13个月。津液内停、实热的出现影响患者生存。结论：部分分组MDS患者生存期较单纯西药治疗延长，提示没有异基因造血干细胞移植条件的MDS患者进行中西医结合治疗可在生存期上获益。中医证型与MDS危险分层存在相关性，实邪的出现提示预后不良，生存期缩短，因此，中医药参与MDS治疗不能单纯采用“补益”中药治疗，还应该根据患者的危险分层，对较高危组患者采用一定“祛邪”药物治疗。

关键词 骨髓增生异常综合征;中位生存期;中西医结合;分层治疗;益髓浓煎方;预后因素;中医证型;益气养血活血

Study on the Survival of Patients with Myelodysplastic Syndromes Treated by Combination of Traditional Chinese and Western Medicine

MAO Xianglin1，CHEN Haiyan2，GUO Ming2，LIU Junxia 2，LANG Haiyan2，LI Ling2，LIAO Junyao2，LIAO Jing2，DING Xiaoqing2

（1 China Southern Airlines Shanghai Branch，Shanghai 200051，China; 2 Dongfang Hospital，Beijing University of Traditional Chinese Medicine，Beijing 100078，China）

Abstract Objective：To observe the median overall survival of myelodysplastic syndromes （MDS） with integrated traditional Chinese and Western medicine，and to explore the factors affecting the survival of patients with MDS.Methods：A total of 57 MDS patients who were voluntarily treated with Yisui Decoction combined with Western medicine，and were admitted to Dongfang Hospital of Beijing Univeristy of Traditional Chinese Medicine from December 2009 to May 2018，were selected as the research subjects.The patients were followed up to death or end of observation.The traditional Chinese syndrome，blood and bone marrow examinations were recorded，and the factors affecting survival were analyzed.Results：The median overall survival of 57 patients was 30 months.The median overall survival of patients with high risk group under 65 years old was 30 months，which was longer than 27 months reported in China.A total of 8 patients with higher risk group receiving decitabine combined with traditional Chinese medicine had a median overall survival of 17 months，which was longer than 13 months reported in the literature treated by decitabine.As traditional Chinese medicine syndrome，the appearance of body fluid stoppage and excessive heat syndrome affected the patients′ survival.Conclusion：The survival of some subgroups of MDS patients is longer than that of Western medicine alone，suggesting that MDS patients without allogeneic hematopoietic stem cell transplantation can benefit from integrated traditional Chinese and Western medicine treatment.There is a correlation between TCM syndrome type and MDS risk stratification.The appearance of excessive syndrome indicates poor prognosis and shortens survival period.Participation of TCM in treatment of MDS should not be treated with “tonifying” Chinese medicine alone.It should also be stratified according to the risk of patients.Patients in the higher-risk group are treated with certain “eliminating evil” drugs.

Keywords Myelodysplastic syndromes; Median overall survival; Combination of traditional Chinese medicine and western medicine; Treatment according to prognostic scoring; Yisui Decoction; Prognostic factors; Traditional Chinese medicine syndrome; Nourishing qi and blood and dredging blood

中图分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.01.029

骨髓增生异常综合征（Myelodysplastic Syndromes，MDS）是一组表现为外周血细胞一系或多系减少、骨髓造血细胞一系或多系发育异常与无效造血的造血干细胞克隆性疾病，其异质性大，部分患者可演变为急性髓系白血病。……