| Objective:To evaluate and analyze the efficacy of Yisui prescription combined with erythropoietin(EPO)in the treatment of relatively low-risk group Myelodysplastic syndromes(MDS),to evaluate and analyze the efficacy of Yisui prescription combined with low-dose decitabine in the treatment of relatively high-risk group MDS,and to explore an effective program of stratified treatment of MDS by combining traditional Chinese and western medicine.Methods:Prospective,one-arm clinical trial study was used,according to the MDS prognostic grouping system,the patients were divided into the relatively low-risk group and the relatively high-risk group.The patients in the relatively low-risk group were given Yisui prescription plus EPO,and the Yisui prescription(granule)was given in 1 bag each time,2 times a day.EPO 10000u,subcutaneous injection,once every other day.The high-risk group was given 1 bag of Yisui prescription(granule)each time,2 times a day,and washed.Desitabine 10mg ivgtl-5.Peripheral blood image,TCM syndrome score,KPS behavioral ability score and other indicators were recorded when the patients were enrolled,2 months after treatment,4 months after treatment,and 6 months after treatment,and the efficacy was determined after 6 months of treatment.To evaluate and analyze the clinical efficacy of this regimenResult:From January 2016 to September 2019,a total of 50 cases were included,including 29 cases in the low-risk group,6 cases died and 2 cases were lost.Among the 21 patients in the high-risk group,6 died and 1 lost.A total of 47 patients were included in the statistical analysis,including 27 patients in the low-risk group and 20 patients in the high-risk group,and 3 patients were lost in total.The median age of patients in the low-risk group was 75 years old,and the total effective rate was 70.37%.The median age of patients in the high-risk group was 78 years,and the total effective rate was 35.00%.As main observation indexes:(1)The peripheral blood:a low risk group of patients with MDS hemoglobin levels at 4 months,6 months is into the group increased significantly,the difference was statistically significant,P<0.05,the comparison between the rest of the group were no statistical difference,but it can be seen that the hemoglobin levels in the group after showing a rising trend,and in the four months rise is bigger.Platelets increased significantly at 2 months after enrollment compared with 2 months after enrollment,showing a statistical difference(P<0.05).The others showed no significant difference.There was no significant difference in white blood cells,platelets and mean red blood cell volume(MCV)before and after treatment(P>0.05).In high-risk group,hemoglobin and platelets were increased after treatment,but the difference was not statistically significant.There was no significant difference in white blood cells,platelets and MCV before and after treatment(P>0.05).(2)TCM syndrome efficacy:The effective rate was 66.67%after 6 months in the low-risk group and 63.64%after 6 months in the high-risk group.After treatment,the score of TCM syndromes in the two groups decreased significantly compared with that before treatment,P<0.05,in which the symptoms of mental fatigue and shortness of breath were significantly improved,P<0.05,and the symptoms of purpura were not significantly improved.(3)KPS behavioral ability:the total improvement rate was 77.78%in the low-risk group after 6 months of treatment,and 58.82%in the high-risk group after 6 months of treatment.There was no significant difference in the KPS behavioral ability score between the two groups after 6 months of treatment and before treatment,P>0.05.Conclusion:(1)The stratified treatment of MDS with combination of traditional Chinese and western medicine has certain curative effect.Relatively low-risk group:①After 4 months of treatment with EPO and Yisui prescription,the hemoglobin content of low-risk patients can be significantly increased.②The combination of Yisui prescription and EPO can effectively improve the clinical symptoms of patients with low-risk MDS,among which the symptoms of fatigue and shortness of breath are significantly improved.③After 6 months of treatment with Yisui prescription and EPO,patients’ KPS behavioral ability score increased slightly,but there was no statistical difference.Relatively higher risk:①After 6 months of treatment with Yisui prescription combined with low-dose decitabine,the hemoglobin content,white blood cells and platelets of the patients showed signs of gradual increase,but there was no statistical difference,so it was necessary to further expand the sample observation.②The combination of Yisui prescription and small dose of decitabine can effectively improve the clinical symptoms of high-risk patients,the symptoms of fatigue,shortness of breath have improved.③After 6 months of treatment with Yisui prescription combined with low-dose decitabine,the KPS behavioral ability score of the patients increased slightly,but there was no statistical difference.Combine traditional Chinese and western medicine treatment of MDS patients were stratified according to may not be affected by factors such as age and diagnosis classification,and according to the revised international prognostic points system(IPSS-R)high and low score,the stand or fall of chromosome karyotype,the types of gene mutation to optimize the comprehensive utilization of such factors as may be the future of Chinese and western medicine combined with precise direction for the treatment of patients with MDS. |
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