A Retrospective Clinical Study On The Distribution Of Syndrome Elements In Myelodysplastic Syndrome And Their Impact On Prognosi

Background and objective:Myelodysplastic syndrome(MDS)is a common malignant blood disease in the elderly.The incidence rate increases with age.MDS is a highly heterogeneous disease that lacks a safe and effective clinical diagnosis and treatment plan.Analyzing this disease from the perspective of traditional Chinese medicine and leveraging its advantages and characteristics is of great significance.This study retrospectively analyzed MDS patients who visited Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine in the past 12 years,analyzed the distribution characteristics of traditional Chinese medicine syndrome elements in the overall,age,gender,and risk stratification of MDS patients,and studied whether the proportion of syndrome elements increased with the increase of risk factors affected prognosis related factors,To provide reference for exploring the distribution pattern of syndrome elements in patients with myelodysplastic syndrome and its impact on prognosis related factors in the future.Method:A retrospective analysis was conducted on 126 MDS patients who visited our hospital from January 1,2010 to December 31,2022 and met the inclusion and exclusion criteria.The patient’s age,gender,general information,previous diagnosis and treatment history,four diagnosis situations,bone puncture related results,whole blood cell analysis,biochemistry,serum ferritin,and lymphocyte subgroup indicators were collected,and a unified case data observation record table was established.SPSS 26.0 software was used for analysis and organization.Firstly,based on the four diagnostic criteria,identify the TCM syndrome elements of patients with MDS,and explore the distribution characteristics of TCM syndrome elements in the overall,age,gender,and risk stratification of MDS patients;Secondly,the focus is on analyzing the syndrome elements that increase in proportion with increasing risk,exploring whether they affect prognosis related factors(including traditional Chinese medicine prognosis,IPSS-R integral system indicators,lymphocyte subgroup indicators),and dividing them into relatively low risk and relatively high risk according to different risk levels.Furthermore,exploring whether they affect prognosis related factors in different risk stratification.Result:①Distribution of syndrome elements:In MDS,the proportion of Qi deficiency syndrome is the highest,followed by blood deficiency syndrome,blood stasis syndrome,Yin deficiency syndrome,phlegm dampness syndrome,etc;The distribution of syndrome elements at different ages showed that the proportion of phlegm dampness syndrome increased with age(P<0.05),and heat toxin syndrome was concentrated in the middle-aged and middle-aged population;The distribution of syndrome elements at different risk levels shows that as the risk increases,the disease progresses,and the proportion of Qi deficiency syndrome and blood stasis syndrome increases.The difference in the proportion of Qi deficiency syndrome is statistically significant(P<0.05).②Out of 126 patients,101 had Qi deficiency syndrome.The 101 patients only presented with Qi deficiency syndrome as 29 cases,accounting for 28.72%;72 cases(71.28%)showed simultaneous occurrence of Qi deficiency syndrome and other syndrome elements.Among the concurrent syndromes,the highest occurrence rate of Qi deficiency and blood stasis is 18 cases,accounting for 17.82%.Subsequently,they are Qi and Blood Deficiency,Qi and Yin Deficiency,Qi and Yin Deficiency with Blood Stasis,Qi and Yin Deficiency with Blood Stasis,Qi Deficiency with Phlegm Coagulation,Qi Deficiency with Phlegm Coagulation with Blood Stasis,and Qi Deficiency with Damp Heat,Qi Deficiency with Qi Stagnation,and Qi and Yin Deficiency with Phlegm Dampness appear less frequently.There was no statistical difference in the distribution of syndrome elements among different risk stratification.③Out of 126 patients,44 had blood stasis syndrome.Among the 44 patients,nosingle blood stasis syndrome was found,and all appeared simultaneously with other syndrome elements.Among the concurrent syndromes,the highest frequency of Qi deficiency and blood stasis was found in 18 cases,accounting for 40.91%.Subsequently,there were mixed syndromes of Qi and blood deficiency and blood stasis,as well as Qi and Yin deficiency and blood stasis.There was no statistical difference in the distribution of syndrome elements among different risk stratification.④The results of traditional Chinese medicine prognosis scores for MDS patients showed that compared with the non blood stasis group,the blood stasis group had a higher traditional Chinese medicine prognosis score(P<0.05).Furthermore,based on the risk stratification,the overall TCM prognosis score of the Qi deficiency group was higher than that of the non Qi deficiency group in the relatively low risk group and the relatively high risk group.The difference in TCM prognosis score of the relatively high risk group was statistically significant(P<0.05).⑤The chromosome karyotypes of MDS patients are divided into five categories:"excellent,good,medium,poor,and extremely poor".Compared with the non blood stasis group,the blood stasis group has a higher overall distribution of chromosome karyotypes in"medium,poor,and extremely poor",and the difference is not statistically significant.Furthermore,according to the risk stratification,there is an inter group difference in the distribution of chromosome karyotypes between the blood stasis group and the non blood stasis group in the relatively low-risk group(P<0.05),with the blood stasis group accounting for a relatively high proportion of chromosome karyotypes;Chromosome karyotypes of non blood stasis group are concentrated in "good".⑥The results of whole blood cell analysis in MDS patients showed that compared with the non blood stasis group,the platelet count(PLT)in the blood stasis group was lower(P<0.05).Furthermore,according to the risk stratification,in the relatively low-risk group,compared with the non blood stasis group,the blood stasis group had a lower PLT,and the difference was not statistically significant;In the relatively high-risk group,compared with the non blood stasis group,the blood stasis group had a lower PLT(P<0.05).⑦Compared with the non blood stasis group,the percentage of auxiliary T lymphocytes(CD4+)in MDS patients decreased.Furthermore,according to the risk stratification,in the relatively low-risk group,compared with the non blood stasis group,the CD4+ percentage in the blood stasis group decreased(P<0.05).Conclusion:The pathogenesis of MDS is characterized by a mixture of deficiency and excess,and the condition is in dynamic changes.In the initial stage,the deficiency is mainly accompanied by pathogenic excess.In the later stage,as the condition progresses,the deficiency gradually develops and the deficiency becomes even more severe.When diagnosing and treating MDS,the combination of syndrome differentiation and disease differentiation is flexible and precise.MDS is a highly heterogeneous disease with varying clinical manifestations.Traditional Chinese medicine treatment also requires differentiation and treatment based on age,course of disease,and physical characteristics.Among the factors of different syndromes,the pathogenesis of patients with blood stasis syndrome is complex,lingering does not heal,bone marrow is knotted,clinical symptoms are obvious,Cytogenetics is poor,and immune function is disordered,which may further aggravate the progress of MDS patients.Therefore,diagnosis and treatment of patients with blood stasis status may be of great significance for judging and improving prognosis;The study also found that many patients with blood stasis syndrome have a decrease in PLT.Clinical diagnosis and treatment should pay attention to the use of blood activating and hemostatic drugs,to stop bleeding without leaving blood stasis,and to promote blood circulation without breaking blood,in order to achieve better clinical efficacy.