Clinical Observation And Experimental Study Of The Traditional Chinese Medicine Compound Yisui Lixue Decoction On Myelodysplastic Syndrome

ObjectiveTo obseve the clinical effect of the traditional Chinese medicine compound Yisui Lixue Yin(CMCYSLXY) on patient with myelodysplastic syndrome(MDS) and the experiment effects of dyshaematopoiesis and apoptosis of bone marrow cells on model rats with MDS induced by Dimethyl benzanthracene(DMBA), explore the mechanism of Yisui Lixue decoction, which will provide experiment basis for applicating of Yisui Lixue decoction in clinic and exploiting of new medicine.MethodsThe topic is divided into 2 parts: clinical observation and experimental research. Clinical observation: The clinical data of 33 patients with MDS were retrospectively analyzed. The patients were treated with CMCYSLXY, decocting 450 ml with water, every agent one day. 1 month was 1 course, the clinical and laboratory findings were counted after treatment of 1, 3, 6 courses, the effect was evaluated after treatment of 6 courses, and the long-term effect was followed up. Experimental study: The model rats with MDS were induced by the chemical mutagens DMBA, divided into 5 groups, 12 rats in each group. The rats were divided into the normal control group(NCG), physiological saline model group(PSMG), compound Zaofan pill group(CZFPG), low dose group of CMCYSLXY(CMCYSLXY-LD) and high dose group of CMCYSLXY(CMCYSLXY-HD). The rats were treated with different drugs for 1 month on the fourteenth day, and executed on the thirty-first day. the detection experiment rats peripheral hemogram, bone marrow hyperplasia degree, dyshaematopoiesis, serum IL-3 and TNF alpha levels and apoptosis related protein, CD34, B-cell lymphoma-2(Bcl-2) and Bcl-2 associated X protein(Bax) expression and apoptosis of bone marrow cells and primitive cells proportion.Results clinical observation: compared with pretherapy, the anemia and bleeding symptoms were improved, the amount of hemoglobinand platelet countin were increased, bone marrow hyperplasia degree and dyshaematopoiesis were reduced. After treatment of 3 courses, white blood cell, hemoglobin increased(P < 0.05), with the increase of treatment, after 6 months, the white blood cells, red blood cells, hemoglobin increased significantly(P < 0.01), the therapeutic effect was evaluated after 6 courses of treatment, complete remission in 13 cases, partial remission in 25 cases, progress in 8 cases, failure in 4 cases, markedly effective rate reached 92%. Follow-up found that with the increase of the treatment course, the patients’ condition relived,after stopping CMCYSLXY recurrence rate is small.Experimental study:(1)Compared with NCG, hemoglobin and platelet count were decreased obviously, the degree of bone marrow hyperplasia was active or hyperactive and dyshaematopoiesis was more obvious in PSMG, which were consistent with the clinical features of MDS;(2)Compared with NCP, the count of peripheral leukocyte, erythrocyte, hemoglobin and platelet were decreased significantly(P < 0.01) in PSMG, the peripheral hemogram of treatment groups was improved significantly compared with that in PSMG(P < 0.05 or P < 0.01), especially in CMCYSLXY-HD(P < 0.01);(3)Compared with NCG, the expression of IL-3 in serum was lower and that of TNF-α was higher(P < 0.01) in PSMG, the expression of IL-3 was increased(P < 0.05) and that of THF-α was decreased(P < 0.05) in the treatment groups, the effects were more obvious in CMCYSLXY-HD(P < 0.01).(4) Compared with NCG, the expression of CD34 and pro apoptotic protein Bax were increased significantly(P < 0.01), the expression of anti apoptotic protein Bcl-2 was decreased significantly(P < 0.01)in PSMG. After treatment, the expression of CD34 and Bax was significantly reduced(P < 0.05 or P < 0.01), the expression of Bcl-2 was increased significantly(P < 0.05 or P < 0.01), and the high dose group was more obvious(P < 0.01);(5)Compared with the NCP, the total apoptosis rate, earlier apoptosis and later apoptosis rate of bone marrow cells were increased(P < 0.01)in PSMG. In treatment groups, the apoptosis rates were decreased(P < 0.05 or P <0.01), especially the total apoptosis rate and earlier apoptosis rate. Only in the CMCYSLXY groups, the later apoptosis rate was decreased(P < 0.01), and the high dose group was better than the low dose group. Conclusion: According to the above results, the conclusions of this study are as follows:(1)The therapy of the CMCYSLXY has good curative effect on the treatment of MDS. It has less adverse reactions and superior long-term effect, which is worth promoting in clinic;(2) Through the experimental study, it confirmes that the CMCYSLXY can effectively enhance the peripheral blood in model rats with MDS, improve bone marrow hyperplasia degree and dyshaematopoiesis. Its mechanism may associated with elevating levels of IL-3, decreasing levels of TNF-α, reducing the expression of CD34 and Bax, increasing the expression of Bcl-2, lessening the blast cells in bone marrow and bone marrow cells apoptosis. It also confirmes that the expression of Bcl-2 was negatively correlated with the rate of apoptosis of bone marrow cells, and the expression of Bax was positively correlated with the rate of bone marrow cells apoptosis at the same time.