双膦酸盐联合化疗治疗多发性骨髓瘤骨并发症的临床观察

Zoledronate combined with chemotherapy in preventing and treating bone disease of multiple myeloma

目的比较唑米瞵酸联合化疗技伊班膦酸联合化疗预防和治疗多发性骨髓瘤（MM）骨并发症的效果及其安全性。方法选择2005年3月至2008年3月中山大学附属第一医院治疗的MM患者77例，按照用药情况分为唑来膦酸联合化疗组24例，伊班膦酸联合化疗组26例，单纯化疗组27例。结果唑来膦酸联合化疗组、伊班膦酸联合化疗组和单纯化疗组患者发生1次骨相关事件（SRE）的比例分别为25．0％、26．9％、48．1％（P=0.145）-唑来膦酸联合化疗组、伊班膦酸联合化疗组发生脊柱压缩性骨折（VCF）的比例分别为4．2％和7．7％，少于单纯化疗组的14．8％（P=0．115）。三组的中位首次发生SRE时问（T—SRE）分别为7．5、6．5和4．5个月（P〈0．001）。唑来膦酸联合化疗组止痛有效率为66．7％，伊班瞵酸联合化疗组有效率为69．2％，单纯化疗组为29．6％，差异有统计学意义（P=0．028）。唑来膦酸联合化疗组治疗后的血钙水平低于伊班膦酸联合化疗组（P=0．016），降至正常水平所需时间也较伊班膦酸联合化疗组短（P=0．04）。唑来膦酸联合化疗组和伊班膦酸联合化疗组的不良反应发生率低，两组不良反应发生率差异无统计学意义（P〉0.05）。结论应用双膦酸盐可减少MM患者SRE的发牛率和VCF。唑来膦酸在减少VCF发生率、减轻骨痛上与伊班膦酸类似，优于单纯化疗组；唑来膦酸在降低血钙水平方而优于伊班膦酸。唑来膦酸临床应用不良反应少，患者均可耐受。

Objective Bone destruction is an important clinical feature in multiple myeloma （MM）. It is critical to prevent and treat skeletal complications, relieve pain, and improve the life quality of MM patients. Biophosphonates act on osteoclasis to inhibit excessive bone resorption, and therefore can reduce the clinical consequences of bone disease in myeloma patients. In our study, we try. to investigate and evaluate the efficacy and safety of zoledronate combined with chemotherapy for treating bone diseases of multiple myeloma. Methods Seventy-seven patients with multiple myeloma which were divided in three groups were retrospectively analyzed. One group received zoledronic acid combined with chemotherapy （n=24）, another group received ibandronic acid combined with chemotherapy （n =26）, while the last one only received chemotherapy （n=27）. Results The morbidity of skeletal related events （SRE） in three groups were 25.0 %, 26.9 %, 48.1% （P =0.145） respectively. The morbidity of vertebral collapse was 14.8 %, which was lower in patients who received zoledronic acid and ibandronic acid （4.2 % and 7.7 %, P =0.115）. The time to first SRE （T-SRE） was 7.5 months, 6.5 months, and 4.5 months in three groups respectively （P =0.00）. There was significant difference in the total response rate in releasing bone pain of patients in three groups, which were 66.7 %, 69.2 % and 29.6 % （P =0.028） respectively. The serum calcium level of patients with hypercalcemia was lower for those who received zoledronate than ibandronate （P =0.016）. No serious adverse events associated bisphophanates were reported. Conclusion Zoledronic acid is similar to ibandronate in reducing the morbidity of vertebral collapse and releasing bone pain, which is superior to the controlled group. It is superior to ibandronate in reducing serum calcium. It is well tolerated, safe and convenient to use.