骨髓增生异常综合征患者IPSS-R与中医证型、症状的相关性

吴洁雅; 王婧; 马薇; 李蕊白; 侯丽

doi:10.16025/j.1674-1307.2023.11.008

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骨髓增生异常综合征患者IPSS-R与中医证型、症状的相关性

临床研究 | 更新时间：2023-12-25

- 骨髓增生异常综合征患者IPSS-R与中医证型、症状的相关性
- Correlation between IPSS-R and TCM syndromes and symptoms in patients with myelodysplastic syndrome
- 北京中医药 2023年42卷第11期页码：1197-1203
- 作者机构：
  
  1.北京中医药大学东直门医院血液肿瘤科，北京 100700
  2.中国中医科学院西苑医院血液科，北京 100091
- 作者简介：
  
  吴洁雅，女，27岁，博士。研究方向：中西医结合防治血液病。
  侯丽，E-mail： houli1203@126.com
- 基金信息：
  
  国家自然科学基金资助项目(81503575;82074240);北京市科技计划课题项目(Z211100002921018);北京市科协金桥工程种子资金项目(ZZ20059);北京市东城区优秀人才（卫生）培养资助项目(2020-dchrcpyzz-38);中华中医药学会青年求实项目(2022-QNQSDEP-19)
- DOI：10.16025/j.1674-1307.2023.11.008
  中图分类号：
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吴洁雅，王婧，马薇，等.骨髓增生异常综合征患者IPSS-R与中医证型、症状的相关性［J］.北京中医药，2023，42（11）：1197-1203.

WU Jie-ya,WANG Jing,MA Wei,et al.Correlation between IPSS-R and TCM syndromes and symptoms in patients with myelodysplastic syndrome[J]. Beijing Journal of Traditional Chinese Medicine,2023,42(11):1197-1203.
吴洁雅，王婧，马薇，等.骨髓增生异常综合征患者IPSS-R与中医证型、症状的相关性［J］.北京中医药，2023，42（11）：1197-1203. DOI： 10.16025/j.1674-1307.2023.11.008.

WU Jie-ya,WANG Jing,MA Wei,et al.Correlation between IPSS-R and TCM syndromes and symptoms in patients with myelodysplastic syndrome[J]. Beijing Journal of Traditional Chinese Medicine,2023,42(11):1197-1203. DOI： 10.16025/j.1674-1307.2023.11.008.

摘要

目的,2,探讨骨髓增生异常综合征（myelodysplastic syndromes，MDS）的修订版国际预后积分系统（IPSS-revised，IPSS-R）与中医证型及症状的相关性。,方法,2,选择2016年1月1日—2021年9月30日北京中医药大学东直门医院血液肿瘤科收治的80例MDS住院患者，对IPSS-R指标（血红蛋白水平、中性粒细胞水平、血小板水平、骨髓原始细胞百分比、细胞遗传学）及中医证型（正虚证型、邪实证型）和舌象临床数据进行分析，明确其相关性。并对其中32例患者进行中医症状分级与IPSS-R积分的相关性分析。,结果,2,IPSS-R与中医证型分布方面，不同IPSS-R患者正虚均以气血两虚证、气阴两虚证为主，然而中危+高危+极高危患者相比极低危+低危患者，脾肾阳虚比例大幅上升。舌质方面，随着IPSS-R积分增加，淡红舌比例下降，其他舌质（包括淡白、淡紫、红舌）比例上升。血细胞减少与中医证型分布方面，单系血细胞减少的患者以气血两虚、气阴两虚为主（分别占12/33和10/33），双系、三系血细胞减少的患者脾肾阳虚证型比例较单系血细胞减少增加。在单系血细胞减少患者中，血红蛋白减少者以“无”邪实为主（9/21），而血小板减少者邪实以“瘀”为主（6/11）。IPSS-R与中医症状分级相关性方面，疲乏分级与IPSS-R呈正相关，与血红蛋白水平呈负相关；瘀斑分级、出血分级与血小板水平呈负相关。,结论,2,脾肾阳虚证与IPSS-R积分升高、多系血细胞减少、骨髓原始细胞增多可能存在相关性；在单系血细胞减少患者中，血红蛋白减少可能与虚证有相关性，而“瘀”可能与血小板减少存在相关性。

Abstract

Objective,2,To explore the correlation between traditional Chinese medicine （TCM） syndromes and symptoms and the revised International Prognostic Score System（IPSS-R） in patients with myelodysplastic syndrome （MDS）.,Methods,2,The clinical data of 80 MDS patients， who were hospitalized in the Department of Oncology and Hematology， Dongzhimen Hospital， Beijing University of Chinese Medicinefrom1 Junuary 2016 to 30 September 2021， were collected. The data of IPSS-R （hemoglobin levels， neutrophil levels， platelet levels， bone marrow blast percentages， cytogenetic results） and TCM syndromes （syndrome of antipathogenic qi deficiency and syndrome of excessive pathogenic factors）with tongue manifestations were analyzed to clarify their correlation. The correlation between IPSS-R and TCM symptoms grading of 32 out of 80 MDS patients were also investigated.,Results,2,By analyzing the correlation between the distribution of IPSS-R score and TCM syndromes，deficiency of antipathogenic qi mainly included deficiency of blood and qi and deficiency of qi and yin， however， compared with extremely low risk+low risk， the proportion of spleen and kidney yang deficiency in patients with moderate risk+high risk+extremely high risk has increased significantly.In terms of tongue body，with the increase of IPSS-R score，the proportion of pale red tongue decreased， and the proportion of other tongue manifestations （including pale white， pale purple and red tongue） increased. The results of hematocytopenia and TCM syndrome distribution showed that the patients with hematocytopenia of one lineage were mainly characterized by deficiency of both qi and blood and deficiency of both qi and yin （12/33 and 10/33，respectively）. Among the patients with hematocytopenia of two lineages and three lineages， the proportion of spleen and kidney yang deficiency was higher than that of one lineage hematocytopenia. In patients who had one lineage hematocytopenia，“none” excessive pathogenic factors was the main syndrome among anemia patients （9/21）， while blood stasis was the main one among thrombocytopenia patients （6/11）. The results of correlation analysis between IPSS-R and TCM symptoms showed that fatigue grading was positively related with IPSS-R and negatively related with hemoglobin levels. The ecchymosis hemorrhage grading was negatively related with the levels of platelet；the grading of ecchymosis and hemorrhage was negatively correlated with platelet level.,Conclusion,2,The syndrome of spleen and kidney yang deficiency may be related with the increase of IPSS-R score，multilineage cytopenia and bone marrow primordial cells.Among patients of one lineage hematocytopenia，the decrease of hemoglobin may be related to deficiency syndrome， while blood stasis may be related with neutropenia.

关键词

骨髓增生异常综合征修订版国际预后积分系统中医证型中医症状

Keywords

Myelodysplastic syndromesIPSS-RTCM syndromesTCM symptoms

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