硼替佐米辅助治疗老年骨肿瘤对患者血清肿瘤坏死因子-α水平的影响

Effects of bortezomib on bone tumor necrosis factor level in elderly patients with bone tumor

目的探讨硼替佐米辅助治疗老年骨肿瘤对患者血清肿瘤坏死因子-α(TNF-α)水平的影响。方法采用回顾性、抽样调查研究方法,2014年3月—2017年1月选择在重庆市开州区人民医院诊治的老年膝关节周围骨肿瘤患者118例作为研究对象,所有患者都给予人工假体置换治疗,对照组给予地塞米松和环磷酰胺辅助治疗,环磷酰胺200 mg/m2在治疗的第1～4 d静脉推注;地塞米松20 mg/d,在术后第1～2、4～5、8～9、11～12 d静脉滴注;观察组在对照组治疗的基础上辅助硼替佐米治疗,剂量为1.3 mg/m2,在治疗第1、4、8、11 d静脉推注,其他治疗方法同对照组。在术前与术后6个月进行膝关节主动屈曲活动度的评定,观察与记录关节退变、囊性变、关节面塌陷、坏死等并发症发生情况;在术前与术后6个月检测TNF-α的浓度;随访至今,对比两组的无进展生存时间。结果观察组与对照组术后6个月膝关节主动屈曲活动度都显著高于术前(P<0.05),观察组也显著高于对照组(P<0.05)。观察组术后6个月的关节退变、囊性变、关节面塌陷、坏死等并发症发生率显著低于对照组(P<0.05)。观察组与对照组术后6个月的血清TNF-α值都显著低于术前(P<0.05),术后6个月观察组的血清TNF-α值也显著低于对照组(P<0.05)。随访至今,观察组与对照组的无进展生存时间(15.77±2.14)个月和(10.87±3.14)个月,观察组显著长于对照组(P<0.05)。结论硼替佐米辅助治疗老年膝关节周围骨肿瘤能有效降低患者的血清TNF水平,促进膝关节功能的恢复,减少术后并发症的发生,从而延长患者的生存时间。

Objective To investigate the effects of bortezomib on bone tumor necrosis factor(TNF)level in elderly patients with bone tumor.Methods Used a retrospective,sampling and survey research methods,From March 2014 to January 2017,118 elderly cases of bone tumor around the knee joint patients in our hospital diagnosis and treatment were seas the research object,all patients were given prosthetic replacement treatment,all patients were given prosthetic replacement treatment,the control group was treated with dexamethasone and cyclophosphamide treatment,the observation group was treated with bortezomib plus dexamethasone and cyclophosphamide therapy.Results The active flexion of the knee joint in the observation group and the control group was significantly higher than that before the operation(P<0.05),and the observation group was also significantly higher than the control group at 6 months after operation(P<0.05).The incidence of complications,such as joint degeneration,cystic degeneration,articular surface collapse and necrosis,was significantly lower in the observation group than the control group at 6 months after operation(P<0.05).The serum TNF-α values of the observation group and the control group at 6 months after operation were(8.36 ±4.25)ng/mL and(14.63 ±4.59)ng/mL,respectively,which were significantly lower than those before operation of(23.57 ±5.62)ng/mL and(23.66 ±4.12)ng/mL(P<0.05),and the observation group was also lower than that of the control group(P<0.05).Up to now,the progression free survival time of the observation group and the control group was(15.77 ±2.14)months and(10.87 ±3.14)months,and the observation group was more than that of the control group(t=8.284,P<0.05).Conclusion The bortezomib can effectively reduce the serum TNF-α level in the treatment of knee joint bone tumors,it can promote the recovery of knee function,reduce postoperative complications and prolong the survival time of elderly patients with knee joint bone tumors.