不同治疗方案对多发性骨髓瘤患者骨病的影响

Effect of different regimens on bone disease of multiple myeloma

目的 探讨不同的治疗方案[BD（硼替佐米＋地塞米松）、TID（沙利度胺＋地塞米松）]对多发性骨髓瘤（MM）骨病的影响.方法 2006年11月至2008年9月,分别应用硼替佐米和沙利度胺联合地塞米松治疗的初治及难治复发MM患者共40例.在2种不同化疗方案前后,对患者进行骨痛评分、X线检查,同时采用ELISA法检测血清成骨细胞抑制因子DKK-1、可溶性细胞核因子κB受体活化因子配体（sRANKL）和抗酒石酸酸性磷酸酶（TRACP）-5b等骨代谢因子的水平.结果 TD组治疗前后中位血清TRACP-5b水平分别为5.94 U/L和4.84 U/L（P＜0.05）.BD组有效患者治疗前后中位血清DKK-1浓度分别为35.11 μg/L和32.03 μg/L（P＜0.05）;血清sRANKL浓度分别为1.05 pmol/L和0.67 pmol/L（P＜0.05）;血清TRACP-5b浓度分别为5.57 U/L和4.90U/L（P＜0.05）.结论 硼替佐米治疗有效的患者通过下调血清DKK-1、sRANKL和TRACP-5b水平从而可能显著增加骨形成活动,减少骨吸收活动;沙利度胺治疗的患者骨吸收活动显著减少.

Objective To explore the difference of effects of two regimens （bortezomib and dexamethasone, BD; and thalidomide and dexamethasone, TD） on bone disease in multiple myeloma（MM）.Methods Forty patients with newly diagnosed and refractory or relapsed MM were treated with BD or TD regimens from Dec 2006 to Sep 2008. Bone pain score and X-ray examination were carried out before and after therapy. Serum levels of DKK-1, sRANKL, OPG and TRACP-5b were measured by ELISA before and 3 months after therapy. Results Serum TRACP-5b concentration was significantly decreased in patients received TD regimen （5.94 U/L before therapy vs 4.84 U/L 3 months after therapy ,P 〈 0.05）, and so did for serum DKK-1 concentration in patients responded to BD regimen （35.11 μg/L before vs 32.03 μg/L 3 months after therapy,P 〈0.05） ;for serum concentration of sRANKL in patients responded to BD regimen （1.05 pmol/L before vs 0.67 pmol/L 3 months after therapy, P 〈 0. 05）; and for serum concentration of TRACP-5b in responders to BD regimen （5.57 U/L before therapy vs 4.90 U/L 3 months after therapy ,P 〈0.05）. Conclusion Bortezomib lowers levels of serum DKK-1 and RANKL in responders, thus leads to normalization of abnormal bone remodeling through the increase of bone formation and reduction of bone resorption. Thalidomide decreases bone resorption regardless of treatmant response.