神经电生理检查对多发性骨髓瘤患者硼替佐米治疗相关周围神经病的预测及诊断意义

Diagnostic value of nerve electrophysiological studies for Bortezomib-induced peripheral neuropathy in multiple myeloma patients

目的:探讨神经电生理检查(nerve electrophysiological studies,NES)对多发性骨髓瘤(multiple myeloma,MM)患者硼替佐米治疗相关周围神经病(Bortezomib-induced peripheral neuropathy,BiPN)的预测及诊断意义。方法:收集79例应用硼替佐米为基础诱导化疗的MM患者,采用临床评估和NES分别评估其基线周围神经病及治疗后的BiPN情况,并比较2种评估方法间的差异。结果:79例MM患者中,31例(39.2%)在硼替佐米用药前已存在基线NES异常,其中最终有20例(64.5%)发生了BiPN,且发生于早期及2级以上BiPN也集中发生在基线NES异常患者中。相较于骨髓浆细胞、血清乳酸脱氢酶(lactic dehydrogenase,LDH)、β2微球蛋白等其他预后相关临床及实验室指标,基线NES异常是对是否发生Bi PN唯一有组间差异的因素(χ2=6.410,P=0.011)。4个疗程后,通过临床评估和(或)NES评估诊断为Bi PN的33例患者中,由临床评估诊断的患者为25例(75.8%),而经后续NES诊断的Bi PN为17例(51.5%),2种评估方法间的阳性率差异无统计学意义(χ2=3.803,P=0.051)。33例诊断为BiPN患者中有9例(27.3%)的临床评估与后续NES判定结果一致,24例(72.7%)两者判定结果不一致,2种评估方法的一致性较差(rn=0.220,P=0.051)。结论:基线NES异常对预测BiPN具有一定的应用价值,但BiPN临床评估的价值依旧重要,后续NES仅能作为Bi PN临床评估的补充。

Objective:To study the diagnostic value of nerve electrophysiological studies(NES)for Bortezomibinduced peripheral neuropathy(BiPN)in patients with multiple myeloma(MM).Methods:A total of 79 patients with MM treated with bortezomib based induction chemotherapy were enrolled.The baseline and post-treatment perpheral neuropathy(PN)was assessed by clinical adverse effects and NES,and the results between these two assessing methods were compared.Results:Thirty-one of 79(39.2%)MM patients had baseline NES abnormalities before treated with bortezomib,of them 20(64.5%)patients developed BiPN at last,and early and grade 2 or higher BiPN also concentrated in patients with abnormal baseline NES.Compared with bone marrow plasma cells,serum LDH,β2 microglobulin and other prognostic related clinical and laboratory indices,abnormal baseline NES was the only index that had significant difference between groups having or not having BiPN(χ2=6.410,P=0.011).After 4 courses of treatment,33 patients were diagnosed as having Bi PN,among them 25(75.8%)patients were diagnosed by clinical adverse effects and 17(51.5%)patients by subsequent NES.There was no significant difference in positive rate between the two assessment methods(χ~2=3.803,P=0.051).Of the 33 patients diagnosed as having BiPN,the diagnostic results of clinical adverse effects and of subsequent NES were consistent in 9 patients(27.3%)and inconsistent in 24 cases(72.7%),the consistency between the two assessment methods was poor(rn=0.220,P=0.051).Conclusions:Abnormal baseline NES has some value for the prediction of Bi PN,however,clinical assessment is still important for Bi PN,and subsequent NES can be served as a supplement for clinical assessment of Bi PN.