硼替佐米诱导的周围神经病变相关诊治进展

Related Diagnosis and Treatment Progress of Bortezomib-Induced Peripheral Neuropathy

多发性骨髓瘤(MM)指骨髓中克隆性浆细胞异常增生,并分泌大量单克隆免疫球蛋白或其片段,从而引起广泛骨质破坏、反复感染、贫血、高钙血症、高黏滞综合征、肾功能不全等一系列临床表现并导致不良后果。蛋白酶体抑制剂[如硼替佐米(BTZ)]已成为治疗MM的基石,但其在延长患者生命的同时也给患者带来了痛苦,其中尤为突出的为因治疗出现的相关周围神经病变。BTZ诱导的周围神经病变(BiPN)主要表现为神经痛和感觉异常,虽然该症状具有可逆性,但部分患者停药后症状仍会持续数月或数年。由于BiPN的发病机制尚不明确,因此目前BiPN尚不能治愈,只能通过仔细的神经系统查体、电生理监测及药物剂量调整来保证患者的生活质量。

Multiple myeloma(MM)refers to the abnormal proliferation of clonal plasma cells in the bone marrow and secretes a large amount of monoclonal immunoglobulin or its fragment,which causes a series of clinical manifestations including extensive bone destruction,repeated infections,anemia,hypercalcemia,hyperviscosity syndrome,and renal insufficiency,resulting in adverse consequences.Proteasome inhibitor[such as bortezomib(BTZ)]has become the main drug for MM,but it also brings suffering to the patient while prolonging life,especially the peripheral neuropathy associated with the treatment.The main feature of BTZ-induced peripheral neuropathy(BiPN)is neuralgia and paresthesia.Although the symptoms are reversible,some patients may suffer these symptoms for months or years after discontinuation of the therapy.The pathogenesis of BiPN has not been clarified so far and there is no way to cure,the quality of life of patients can only be improved through careful physical examination of nervous system,electrophysiological monitoring and dose adjustment.