【摘要】 目的探讨对免疫抑制治疗(IST)无效的重型再生障碍性贫血(SAA)的治疗方法。方法用中西医结合治疗IST无效的SAA 62例。将治疗过程分3期:危重期用羚羊乙癸汤(羚羊角粉1.2g黄连6g焦栀子12g生地30g白茅根50g黄柏9g丹皮12g阿胶9g红枣30g炙甘草6g等)与二至补髓汤(女贞子120g旱莲草100g制首乌24g枸杞子12g生地90g黄芪60g当归9g阿胶9g金银花30g莲子芯12g等)交替服用,每日1剂,煎2次分服,同时给予丙酸睾酮50mg隔日肌肉注射,治至好转期。发热者在羚羊乙癸汤中加生石膏60g,知母60g,蒲公英30g,白英30g,白薇30g,三叶青15g等。好转期用鸡血藤复方治疗(肾阳虚给予鸡血藤拯阳汤:鸡血藤100g黄芪60g红参3g补骨脂12g菟丝子18g当归12g仙灵脾18g葫芦巴6g制首乌24g女贞子30g旱莲草30g紫河车6g等。同时给予丙酸睾酮50mg隔日肌肉注射。肾阴虚给予鸡血藤益精汤:女贞子100g旱莲草100g生地90g鸡血藤30g菟丝子12g补骨脂6g制首乌30g阿胶9g枸杞子9g丹参24g黄芪30g当归6g等)每日1剂,煎2次服。治至恢复期。恢复期逐渐减药至停药随访。结果 62例患者经6～57个月的治疗,基本治愈12例(19.4%),缓解14例(22.6%),明显进步8例(12.9%),无效28例(45.2%),总有效率54.8%。初诊时体温37.6～38.5℃者23例,退热(<37.5℃)所需时间2h～6天。>38.5℃者20例,退热所需时间4h～5天。初诊时因IST而引起的肝、肾功能异常(ALT、AST、BUN、Cr)者26例,经中西医结合治疗2个月后,25例恢复正常。结论 IST无效的SAA的治疗有其特殊性,中西医结合分期论治符合IST无效的SAA的病理生理,改善和保护骨髓造血微环境可能是治疗IST无效的SAA的关键所在。而中药的抗菌消炎作用有阻断病情恶化的趋势。更多还原

【Abstract】 Objective To explore treatment methods for patients with severe aplastic anemia (SAA) failing in immunosuppressive therapy (IST). Methods Totally 62 SAA patients failing in IST were treated by integrative medicine (IM). The treatment course was divided into three stages: the critical emergency stage, the improvement stage, and the recovery stage. In the critical emergency stage, patients were treated with Lingyang Yigui Decoction (LYD, consisting of 1.2 g antelope horn, 6 g coptis chinensis, 12 g stir-baked Fructus Gardeniae, 30 g rehmannia rhizoma, 50 g lalang grass rhizome, 9 g amur corktree bark, 12 g Cortex Moutan, 9 g ass-hide gelatin, 30 g red date, 6 g prepared licorice root, etc.) and Erzhi Busui Decoction (EBD, consisting of 120 g glossy privet fruit, 100 g eclipta prostrata, 24 g prepared Gold Theragran, 12 g fructus lycii, 90 g rehmannia rhizoma, 60 g astragalus, 9 g Angelica sinensis, 9 g ass-hide gelatin, 30 g honeysuckle flower, 12 g lotus plumule, and so on) alternatively, one dose daily, decocted twice, taken in two portions. Meanwhile, 50 mg Testosterone Propionate was intramuscularly injected every other day to the improvement stage. Those with fever were treated with LYD by adding 60 g gypsum, 60 g common anemarrhena, 30 g dandelion, 30 g bittersweet herb, 30 g blackend swallowwort root and rhizome, 15 g hemsley rockvine root tuber, and so on. In the improvement stage patients were treated with Jixueteng Compound (Jixueteng Zhengyang Decoction was administered to those of Shen-yang deficiency syndrome: consisting of 100 g spatholobus suberectus, 60 g astragalus, 3 g red ginseng, 12 g psoralea corylifolia, 18 g dodder seed, 12 g angelica, 18 g Herba Epimedii, 6 g common fenugreek seed, 24 g Gold Theragran, 30 g glossy privet fruit, 30 g eclipta prostrata, 6 g dried human placenta, and so on). Meanwhile, 50 mg Testosterone Propionate was intramuscularly injected every other day. Jixueteng Yijing Decoction was administered to those of Shen-yin deficiency syndrome: consisting of 100 g glossy privet fruit, 100 g eclipta prostrata, 90 g rehmannia rhizoma, 30 g spatholobus suberectus, 12 g dodder seed, 6 g psoralea corylifolia, 30 g prepared Gold Theragran, 9 g ass-hide gelatin, 9 g fructus lycii, 24 g Salvia miltiorrhiza, 30 g astragalus, 6 g angelica, and so on), one dose daily, decocted twice, taken in two portions. The treatment lasted to the recovery stage. The medication was gradually reduced to the follow-ups of drug discontinuance. ResultsAfter 6-57 months of treatment, 12 patients (accounting for 19.4%) were basically cured, 14 (22.6%) relieved, 8 (12.9%) markedly improved, 28 (45.2%) ineffectively, with the total effective rate of 54.8%. Totally 23 patients had the body temperature ranging 37.6-38.5 ℃ at the first visit to our hospital. They took 2 h6 days to have pyretolysis (<37.5 ℃) after treatment. Twenty patients with body temperature higher than 38.5 ℃ took 4 h5 days to have pyretolysis after treatment. Totally 26 patients suffering from IST induced abnormalities of liver and renal functions (ALT, AST, BUN, and Cr) at the first visit were treated by IM for 2 months. They were restored to the normal levels in 25 cases. Conclusions The treatment of SAA failing in IST had its specificity. The staging targeted treatment is in line with its pathophysiology. The key points for its treatment might be lie in the improvement and protection of hematopoietic microenvironment of bone marrows. The antisepsis and anti-inflammation of Chinese herbs hindered its aggravating tendency.更多还原