| ObjectiveTo establish a scoring method for the general health status of patients with leukemia,which is used to judge the tolerance of patients receiving different doses of chemotherapy,and to establish a functional predictive model as the carrier to assist clinical chemotherapy decision-making.to explore the clinial efficacy of complementary traditional Chinese and western medicine in the treatment of senile leukemia;summarize the effective TCM treatment principles of traditional Chinese medicine in the treatment of senile leukemia and the compatibility of basic prescriptions and medicines.MethodsIn study 1,the AEM evaluation system scale(hereinafter referred to as AEM scale)was developed hased on age,physical status and vital organ function scores,and the clinical data of leukemia paltients who were hospitalized in the Hematology Department of the first afiliated Hospital of Tianjin University of traditional Chinese Medicine from 2013 to 2020 were collected.The reliability and validity of AEM.scale were tested Logistic regression analysis scale was used to analyze the fitness of the model The linear regrssion relationship between AEM total score,ECOG score and chemotherapy outcome was analyzed under different chernotherapy doses-The percentage distribution of AEM total score was analyzed under different chemotherapy outcomes and different chemotherapy doses.The distribution rules of chemotherapy dose,chemotherapy outcome,the number and frequency of chemotherapy outcome in each group were analyzed and summarized under the condition of defining each integral term.In study 2,elderly leukemia patients hospitalized in the Hematology Department of the first affiliated Hospital of Tianjin University of traditional Chinese Medicine from 2013 to 2020 were evaluated by AEM scale,and Fisher discriminant analysis was used to stablisha predictive function model for the outcome of chemotherapy.According to whether taking oral traditional Chinese medicine decoction as adjuvant chemotherapy during hospitalization,elderly patients with leukamia were divided into western medicine control group and complementary traditional Chinese and western medicine group The effective rate of bone marrow image,the lowestnumber of neutrophils,the duration of granulocytosis and the significant level of liver and kidney function indexes after chemotherapy were analyzed,and the effect of syndrome differentiation oral traditional Chinese medicne.decoction adjuvant chemotherapy on elderly patients with leukemia was observed.In study3,the elderly leukemia patients who were effective after chemotherapy in the Department of Hematology of the first affiliated Hospital of Tianjin University of traditional Chinese Medicine from 2013 to 2020 were divided into western medicine control group and western medicine complementary group according to syndrome differentiation The CR rate,the lowest value of neutrophils,the duration of granulocytosis and the function of liver and kidney in the two groups were compared to explore the advantages of traditional Chinese medicine in the treatment-Collect the prescription of traditional Chinese medicine decoction in the complementary group of traditional Chinese and western medicine,analyze the types and frequency of monarch and minister drugs,the degree of support and confidence of monarch and minister drugs,and sum up the treatment principles of traditional Chinese medicine according to the idea of syndrome differentiation and treatment of traditional Chinese medicine.ResultsStudy ?1.Cronhach'sAlpha coefficient of AEM scale=0.725,KaiserlyMeyerMel Olkin coefficient=0.760 and Bartlett significance level 0.00.2.AEM scale was used to evuate the clinical data of leukemia patients unndergoing chemotherapy.Binary logistic regression was used to analyze the model fit between the integral items of AEM scale and the outcome of chemotherapy.Hosmer-Lemeshow test showed that the significant score was 0.427 and the total percentage was 63.0%.The regresion coefficient was 3.013,and the odds ratio was Exp(B)=20.342.Binary logistic regression analysis was used to analyze the model fit the ideal degree distribution of each integral item of AEM scale and the outcome of chemotherapy.Hosmer-Lemeshow test showed that the significant score was 0.377 and the total percentage was 70.8%.The number of individual scores was 0.025 and the regression coefficient was 0.819,and the risk ratio Exp(B)was 0.441.The signifcance of the number of single integral is 0.025 and the regression coefficient is 0.357,the odds ratio is Exp(B)=0.700,and the significnce of the number of monomial integral is 0,and the regression coeffient is 0.717,the odds ratio Exp(B)is 0.488.The results show that the number of monomial integrals is 0.000 and the regression coefficient is 0.717,and the odds ratio is 0.700.Multivariate ordered logistic regression analysis was used to analyze the model fitting degree between the integral items of AEM scale and the outcome of chemotherapy.The model fitting information was significant(P<0.05)and the parallel line test was significant(P<0.01).The influence coefficient of alt score was 1.543,and the prothrombin prolongation time score was 0.002 and the influence coeficient 2.097.Multiple ordered logistic regression analysis was used to analyze the model fit between the ideal degree distribution of each integral item of AEM scale and the outcome of chemotherapy,the model fitting information was significant(P<0.05)and the parallel line test was significant(P=0.404),the number of single score was 3(P<0.002)and the influence coefficient was 1.315,the number of single score was 2(P<0.01)and the influence coefficient 0.557.3.The clinical data of leukemia patients undergoing chemotherapy were evaluated with AEM scale.In the case of medium and high dose chmotherapy,the total score of AEM was R=0.428,the Pearson coefficient of significance was 0.654,the influence coefficient was 0.230,the influence coefficient was 0.348,the Pearson coefficient of 0.021 was 0.590,and the influence coefficient was 0.770.In the case of standard dose chemotherapy,the total score of AEM R=0.024,the coefficient of influence was 0.036(R=1.012)and the coefficient of influence was 0.155(P<0.05).In the case of reduced dose chemotherapy,the total score of AEM.was R=0.228,the coefficient of influence was 0.477,the coefficient of influence was 0.121,the coefficient of influence was 0.252,the coefficient of influence was 0.502,and the coefficient of influence was 0.428.The results showed that the total score of ECOG was 0.228,fthe coefficient of influence was 0.477,the coefficient of influence was 0.252,and the coefficient ofinfluence was 0.502.4.Using the AEM scale to evaluate the clinical data of leukemia patients undergoing chemotherapy,with the aggravation of the degree of injury in the outcome of chemotherapy,the mean and median of the total score of AEM increased;with the decrease of the dose of chemotherapy,the and median of the total score of AEM increased,if the score of any single item in the AEM scale score?3,the proportion of death due to chemotherapy outcome was 25%,and chemotherapy was not recommended If chemotherapy is considered,a standard dose of chemotherapy is recommended When the sum of any two scoresin the AEM scale score?4,the proportion of death due to chemotherapy outcome is 13.48%.It is recommended that chemotherapy be carried out cautiously-If ch emotherapy is considered,a standard dose of chemotherapy is recommended When the sum of 2?any 2 integrals in the AEM scale is less than 4,standard dose chemotherapy is recommended When the sum of any three scores in the AEM scale score?6,the proportion of death due to chemotherapy outcome is 11.76%.It is recommended that chemotherapy be tarried out cautiously.If chemotherapy is considered,a standard dosa of chemotherapy is recommended When the sum of 3?any 3 integrals in the AEM scale is less than 6,standard dose chemotherapy is recommended When the sum of any 4 items in the AEM scale score?8,the proportion of death due to chemotherapy outcome is 13.79%.It is recommended that chemotherapy be carried out cautiously.If chemotherapy is considered,a standard dose of chemotherapy is recommended.In the score item of AEM scale,the total score of AEM is?10.00,and the proportion of death due to chemotherapy outcome is 16.67%.It is recommended that chemotherapy be carried out cautiously.If chemotherapy is considered,a standard dose of chemotherapy is.recommended.Study?5.The AEM scale was used to evaluate the clinical data of elderly leukemia patients undergoing chemotherapy,and the Fisher discriminant analysis method was used to establish a predictive function model for the outcome of chemotherapy,in which the eigenvalue of typical discirminant function 1 was 1.134 and 0.04,The existing predictive function model showed that the accuracy of predicting the outcome of chemotherapy was 79.1%There was no significant difference in the effective rate after chmotherapy betwen the western medicine control group and the complementaTy traditional Chinese and western medicine group,and there was no significant difference in the.independent sample T test of UA inidex between the western medicine control group and the complementary traditional Chinese and western medicine group and there was a significant difference in the independent sample T test of Fg index between the western medicine control group and the western medicine complementary group,and the mean Fg of the western medicine complanentary group was 3.7842 signifcantly higher than that of the western medicine control group.The Fg mean value of the western medicine control group was signifirantly higher than that of the weste medicine control group(2.9918).There were ignifcant differences in the lowest neutrophil count,PT and APTT indexes between the western medicine control group and the western medicine complementary group(p<0.05).In the Chinese and western medicine complemeatary group,the median neutrophil count was 0.06(0.02),the median of PT index was 12.50(11.60,13.88)and the median of APTT index was 31.95(27.25,38.93).In the western medicine control group,the median number of neutrophils was 0.01,11.4(10.55,12.88)and 23.38(23.38,31.78)of neutrophils,PT and APTT,respectively.Study ?6.AEM scale was used to evaluate the clinical data of elderly patients with leukemia who were effective after chemotherapy.The chi-square test of the CR rate of the western medicine control group and the complementary traditional Chinese and western medicine group after chemotherapy showed that the chi-square test was 0.592 and the chi-square value was 0.287,and there was no significant difference.The lowest value of neutrophils,the duration.of granulocytosis,,the Mann-WhitneyU values of and APTT in the western medicine control group and the western medicine complementary group were 230.5,159 284 and 315 respectively,and there was significant difference in Fg index(P<0.017).In the western medicine control group,the median number of neutrophils was 0.02(0.22),the median of duration of granulocytosis 12.5(7.8),the median of PT was 11.1(10.4),the median of APTT was 27.3(23.4),and the mean of Fg was 2.9±0.74,In the complementary group of traditional Chineese and western medicinen the median of the low.est neutrophil was 0.21,the median duration of gramulocytopenia was 7,5,the median of PT was 12.2,the median of APTT was 30 7,and the mean of Fg was 3 61.3.7.The effective prescriptions of traditional Chinese medicine for elderly patients with leukemia after chemotherapy were collected,in which the treatment method was mainly tonifying kidney detoxification and removing blood stasis in chemotherapy period,kidney tonifying,heat clearing and detoxification in bone marrow inhibition stage,kidney tonifying and detoxifification in interphase of chemotherapy,and kidney tonifying and detoxification method in overall syndrome differentiation.There were 4294 Kinds of compatibility combinations of monarch and minister drugs during chemotherapy,myelosuppression and interchemotherapy Among them,the compatibility of monarch and minister drugs with support degree?50%is the same,and honeysuckle,fcrsythia,Hedyotis diffusa,Ophiopogon japonicus and Schisandra chinensis are mainly compatible with each other Conchusion1.AEM scale includes the advantages of ECOG score and combines the patient's age,vital organ function and other score items,which can comprehensively judge the patient's tolerance to chemotherapy,and can predict the outcome of chemotherapy to a certain extent and give relevant chemotherapy recommendations.For the occurrence of chemotherapy outcome injury and the severity of chemotheraapy outcome injury,there are predictive indicators in the AEM scale for reference.2.AEM scale was used to evaluate elderly patients with leukemia and Fisher discriminant analysis was used to establish a predictive function model for predicting the outcome of chemotherapy.This functional model is effective and accurate for predicting the outcome of chemotherapy,and the accuracy of the model can be improved by constantly expanding the data.3.For the elderly patients with leukemia,there was no significant difference in the effective rate after chemotherapy between the western medicine control group and the complem entary traditional Chinese and western medicine group.Syndrome differentiation oral traditional Chinese medicine decoction participating in chemotherapy could significantly improve the fibrinogen.(Fg)and the minimum number of neutrophils,and prolong the plasma prothrombin time((PT))and activated partial thromboplastin time(APTT)(activated partial thromboplastin time).For the elderly lenkemia patients who are effective after chemotherapy(CR+PR),syndrome differentiation oral Chinese medicine decoction can significantly improve and shorten the minimum value of neutrophils and the duration of granulocytopenia,respectively,and significantly improve and prolong the indexes of Fg,PT and APTT.4.The analysis of the prescription of traditional Chinese medicine decoction for effective(CR+PR)elderly patients with leukemia after chemotherapy showed that tonifying the kidney and detoxifying and removing blood stasis was the main method in the period of chemotherapy,kiddney-tonifying,heat-clearing and detoxifying in the period of bone marrow inhibition,kidney-tonifying and detoxification in the interphase of chemotherapy,and the overall syndrome differentiation and treatment was the method of tonifying kidney and detoxi.The compatibility rules of monarch and minister drugs during chemotherapy,myelosuppression and interchemotherapy were analyzed(support? 50%),represented by the compatibility of honeysuckle,forsythia,Hedyotis diffusa,Ophiopogon japonicus and Schisandra chinensis. |
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