张羽 朱光荣 张如升

摘要 目的：探究益氣养阴方治疗急性髓系白血病（AML）的疗效及对患者血象、骨髓象的影响。方法：选取2014年5月至2017年12月江苏省中医院收治的AML患者77例作为研究对象，按照随机数字表法分为对照组（n=38）与观察组（n=39）。对照组行常规化疗，观察组在对照组的基础上给予益气养阴方治疗。检测2组治疗前后细胞免疫状态和血清VEGF、TGF-β1水平及血象、骨髓象指标，并统计临床总缓解率（ORR）及不良反应发生率。结果：治疗2个疗程后对照组全血CD3+、NK比例较治疗前降低，观察组较治疗前及对照组升高，差异有统计学意义（P<0.05）;观察组全血CD4+比例及CD4+/CD8+较治疗前及对照组升高，差异有统计学意义（P<0.05），CD8+比例较治疗前及对照组降低，差异有统计学意义（P<0.05）;治疗后2组全血白细胞计数（WBC）及骨髓原幼细胞比例逐渐降低，且观察组低于对照组，差异有统计学意义（P<0.05），治疗后对照组全血血小板计数（PLT）、血红蛋白（Hb）水平逐渐降低，观察组先降低后升高，且观察组高于对照组（P<0.01）;治疗后2组血清血管内皮生长因子（VEGF）较治疗前降低，且观察组低于对照组，差异有统计学意义（P<0.05），TGF-β1较治疗前升高，且观察组高于对照组，差异有统计学意义（P<0.05）;治疗后观察组临床ORR高于对照组，差异有统计学意义（P<0.05）;2组不良反应发生率差异无统计学意义（P>0.05）。结论：益气养阴方可提高AML患者细胞免疫功能，改善造血功能，抑制AML细胞增殖，且临床ORR优于单纯化疗。

关键词 急性髓系白血病;化疗;益气养阴方;疗效;血象;骨髓象;细胞免疫;不良反应

Abstract Objective：To explore the effects of Yiqi Yangyin Formula in the treatment of acute myeloid leukemia （AML） and the influence on patients′ hemogram and myelogram.Methods：A total of 77 AML patients were selected as the research objects and were divided randomly into a control group （n=38） and an observation group （n=39）.The control group received conventional chemotherapy，and the observation group treated with Yiqi Yangyin Formula.The cellular immune status and serum VEGF，TGF-β1 levels，blood and bone marrow indicators were detected before and after treatment in the 2 groups，and the total clinical remission rate （ORR） and the incidence of adverse reactions were detected.Results：The proportion of whole blood CD3+，NK in control group decreased 2 courses after treatment than those before treatment，while those in observation group were higher than those before treatment and control group，the difference was statistically significant （P<0.05）.The proportion of whole blood CD4+ and CD4+/CD8+ in observation group increased than those before treatment and control group，the difference was statistically significant （P<0.05）; the ratio of CD8+ was lower than before treatment and the control group，and the difference was statistically significant （P<0.05）; after treatment，the level of complete blood white blood cell （WBC） and the proportion of bone marrow blasts in the 2 groups gradually decreased，and the observation group was lower than the control group，the difference was statistically significant （P<0.05）.After treatment，the complete blood platelet count （PLT） and hemoglobin （Hb） levels of the control group gradually decreased，and the observation group first decreased and then increased.And the observation group was higher than the control group，the difference was statistically significant （P<0.01）; the serum vascular endothelial growth factor （VEGF） of the 2 groups after treatment was lower than that before treatment，and the observation group was lower than the control group，the difference was statistically significant （P<0.05），TGF-β1 was higher than before treatment，and the observation group was higher than the control group，the difference was statistically significant （P<0.05）; after treatment，the clinical ORR of the observation group was higher than the control group，and the difference was statistically significant （P<0.05）; there was no significant difference in the incidence of adverse reactions between the 2 groups （P>0.05）.Conclusion：Yiqi Yangyin Formula could enhance the cellular immune function of AML patients，improve the hematopoietic function，inhibit the proliferation of AML cells，and the ORR is better than that of chemotherapy alone.

Keywords Acute myeloid leukemia; Chemotherapy; Yiqi Yangyin Therapy; Curative effect; Hemogram; Myelogram; Cellular immune function; Adverse reactions

中图分类号：R289.5;R733文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.14.018

急性髓系白血病（Acute Myeloid Leukemia，AML）是一种造血系统的恶性疾病，白血病细胞会浸润全身各个脏器组织，患者会出现骨髓异常和正常血细胞受损，临床表現为骨痛、淋巴结增大、贫血及器官浸润等，其发病率及病死率较高[1-2]。目前治疗AML以化疗为主，其可控制患者病情进展，但化疗药物会导致患者出现恶心、食欲减退、免疫抑制等不良反应[3]。中医认为久病致虚、内伤七情、邪气过盛、劳倦所伤、脏腑失调而累及骨髓，导致AML发生，故以“补其不足”“损其有余”为治疗总则，即以扶正祛邪、攻补兼施为主，佐以清热解毒。益气养阴方具有清热解毒、凉血活血、益气养阴等功效，可提高机体免疫力和调控白血病骨髓细胞基因甲基化等[4-5]。……