维生素D_3治疗急性骨髓纤维化取得缓解——附一例报告

本文报道一例急性骨髓纤维化(AMF),男、52岁,严重贫血(Hb19g/L)经多种升血药物、胎肝细胞悬液输注等治疗20个月无明显好转;靠输血维持生命。经肌注维生素D_3(VD_3)后两个月病情显著缓解,不需输血,Hb稳步升至93g/L出院。随访9个月生活自理,Hb114g/L,髓象及骨髓活检均明显好转,无副反应。VD_3治疗AMF是一新进展,此病人是国内取得临床成功的首例。据文献证明VD_3在体内羟化为1,25(OH)_2D_3活性物质能抑制异常巨核细胞增生,减少促进MF的PDGF,并诱导髓细胞向单核细胞、臣噬细胞和粒细胞方向成熟,释放胶原酶促进胶原裂解,因而MF改善。

Remission of Acute Myelofibrosis after Vitamin D_3 Therapy: A Case Report

This article is to report the successful treatment of a case of acute myelofibrosis(AMF) with vitamin D_3. A male,aged 52,was admitted because of severe anemia(hemoglobin 19g/L) for more than 6 months.He had been treated with various antianemic agents and fetal liver infusion for more than 20 months without any effects.He still had to live on repeated blood transfusions.After 2-month-treatment with vitamin D_3 injections,remarkable remission was obtained and his hemoglobin level steadily rose to 93g/L without transfusion.In the follow-up period of 9 months,the patient did well.He took care of his own daily life and the hemoglobin level continued to rise to 114 g/L.The findings of the bone marrow improved correspondingly.No side reaction against vitamin D was observed.This is the first case of AMF treated successfully with vitamin D reported in our country.It is known that vitamin D_3 can be converted in vivo through hydroxylation into 1,25(OH)_2D_3.This active hormonal metabolite can inhibit the proliferation of abnormal megakaryocytes,decrease the synthesis of platelet-derived growth factor which can promote the genesis of myelofibrosis,and induce the maturation of myeloid cells towards monocytes,macrophages and granulocytes which can release collagenase to decompose collagen in the marrow aod improve myelofibrosis.