黄芪水煎剂联合地西他滨、CAG方案治疗老年急性髓系白血病的临床研究

  目的  研究黄芪水煎剂联合地西他滨、CAG方案治疗老年急性髓系白血病(Acute myeloid leukemia，AML)的临床疗效及可能机制。  方法  将2018年1月至2021年7月河北省中医院收治的132例老年AML住院患者随机分成对照组和治疗组各66例。对照组予地西他滨联合CAG方案治疗，治疗组在对照组治疗基础上加用黄芪水煎剂，疗程均为12个月。治疗后观察2组临床疗效、支持治疗及不良反应发生情况，检测2组患者治疗前后免疫功能指标(CD3+、CD4+、CD8+、IgG、IgA、IgM)及凋亡相关指标(Bcl-2、Bax、Bak、Bcl-xl)mRNA表达水平变化情况。  结果  治疗后，治疗组总有效率高于对照组(P < 0.01)，支持治疗及不良反应发生率低于对照组(P < 0.05，P < 0.01)；2组患者CD3+、CD4+、CD8+细胞比例及IgG、IgA、IgM水平显著降低(P < 0.01)，治疗组CD3+、CD4+、CD8+细胞比例低于对照组(P < 0.01)；治疗组Bcl-2、Bcl-xl mRNA表达水平显著降低(P < 0.01)，Bax、Bak mRNA表达水平明显升高(P < 0.01)，对照组Bcl-2 mRNA表达水平明显降低(P < 0.01)，Bax mRNA表达水平显著增加(P < 0.01)；治疗组Bcl-2、Bcl-xl mRNA表达水平低于对照组，Bak mRNA表达水平高于对照组(P < 0.01)。Logistic回归分析结果显示:影响老年AML患者预后的独立危险因素主要包括年龄、未使用黄芪水煎剂联合地西他滨治疗、免疫功能低下以及不良反应(P < 0.01)。  结论  黄芪水煎剂联合地西他滨、CAG方案能显著改善老年AML患者临床疗效，改善机体免疫功能指标，其机制可能与调节凋亡相关因子表达有关。 

Clinical Study on the Treatment of Acute Myeloid Leukemia in the Elderly with the Huangqi Decoction Combined with Decitabine and CAG Regimen

  OBJECTIVE  To study the clinical efficacy and possible mechanism of the additional Huangqi Decoction on treating acute myeloid leukemia (AML) in the elderly.  METHODS  A total of 132 elderly AML inpatients admitted to Hebei province hospital of Chinese medicine from January 2018 to July 2021 were randomly divided into the control group and the treatment group of 66 cases each. The control group was treated with Decitabine combined with conventional CAG regimen, while the treatment group was given with Huangqi Decoction based on the therapies in the control group. After treatment, we observed the clinical efficacy, supportive treatment, and occurrence of adverse reactions in both groups. In addition, we measured the changes of mRNA expression levels of immune function indexes (CD3+, CD4+, CD8+, IgG, IgA, IgM) and apoptosis-related indexes (Bcl-2, Bax, Bak, Bcl-xl) before and after treatment in the two groups.  RESULTS  After treatment, the total effective rate of the treatment group was higher than that of the control group (P < 0.01), and the incidence of supportive treatment and adverse reactions was lower than that of the control group (P < 0.05, P < 0.01). The proportion of CD3+, CD4+ and CD8+ cells and the levels of IgG, IgA and IgM in both groups were significantly reduced (P < 0.01), while the proportion of CD3+, CD4+ and CD8+ cells in the treatment group was lower than that of the control group (P < 0.01). In addition, Bcl-2 and Bcl-xl mRNA expression levels were significantly reduced (P < 0.01), but Bax and Bak mRNA expression levels were significantly increased in the treatment group (P < 0.01). In comparison, only Bcl-2 mRNA expression levels were significantly reduced (P < 0.01) and Bax mRNA expression levels were significantly increased in the control group (P < 0.01). On top of that, Bcl-2 and Bcl-xl mRNA expression levels were lower in the treatment group than in the control group, but Bak mRNA expression levels were higher in the treatment group than in the control group (P < 0.01). Logistic regression analysis showed that the independent risk factors affecting the prognosis of elderly AML patients mainly included age, non-use of Huangqi Decoction combined with Decitabine treatment, low immune function, as well as adverse reactions (P < 0.01).  CONCLUSION  Huangqi Decoction combined with Decitabine and CAG regimen can remarkably improve the clinical efficacy of elderly AML patients and improve the body's immune function indexes. Thus, the mechanism may be related to the regulation of apoptosis-related factor expression.