経口鉄剤不応性の貧血に対する六君子湯による治療の試み  [in Japanese] A Strategy for Iron Refractory Anemia by Rikkunshi-to  [in Japanese]

鉄剤に不応性の貧血に対し, 六君子湯エキス剤を投与し前後の血液学的所見, 併発する基礎疾患等を検討した。評価可能であった11症例の投与前血色素量(Hb)は10.7±0.8g/dl, 投与後は11.5±0.8g/dl(平均投与期間17.3±11.6カ月)で有意に投与後のHbは上昇した。11例のうち9症例(82%)で貧血の改善を認めた。併発症の検討では, 8例(73%)の症例で萎縮性胃炎, 逆流性食道炎等の消化器疾患を併発していた。本剤が奏効した理由として, 人参抽出成分による骨髄細胞DNAの生合成促進作用を介した造血能の改善, 消化吸収機能改善による鉄吸収および利用の改善, 食欲改善による経口鉄摂取量の増加, 等が考えられた。六君子湯は経口鉄剤不応性の貧血の改善に試みる価値のある薬剤と考えられたが, そのメカニズム, 至適病態の決定は今後の重要な検討課題である。

During the administration of Rikkunshi-to, hematological findings and complications of underlying disease were examined in patients with refractory anemia treated with oral iron preparations. In all 11 evaluative cases, hemoglobin levels before the administration of Rikkunshi-to were 10.7±0.8g/dL, and 11.5±0.8g/dL post-administration (mean administration period 17.3±11.6 months), indicating a significant hemoglobin level increase. In 9 out of 11 cases (82%), an improvement in anemia was observed. Eight out of 11 cases (73%) had atrophic gastritis, reflux esophagitis, or other gastrointestinal disease complications. Rikkunshi-to is considered to be effective such factors as : an improvement in hematopoiesis through a promotion of DNA synthesis in bone marrow cells with prostisol ; and an improvement in iron absorption and utilization with improving appetite, although, the exact mechanisms have yet to be elucidated. In conclusion, Rikkunshi-to can be considered an appropriate medication for the improvement of refractory anemia treated with the administration of oral iron preparations. However, its mechanism of action, as well as its recommended administration for specific disease states remain important issues for the future.