中西医结合治疗多发性骨髓瘤的临床疗效观察

目的观察中药联合硼替佐米为主方案治疗初发或复发难治性多发性骨髓瘤的疗效及不良反应。方法22例多发性骨髓瘤患者采用中药联合硼替佐米治疗。中医根据临床所见，分为痰瘀互结、肝肾两虚两型予以辨证施治，从化疗之13起，每日一剂，煎取200ml，早晚分服。西药为硼替佐米1．0～1．3mg／m2，静脉注射，第1、4、8、11天，3周为1个疗程，所有患者接受1～5个疗程治疗。根据EBMT疗效标准判断临床疗效并观察不良反应。结果VGPR／CR11例（50％），PR7例（33％），总有效率83％。完成2个疗程可评价的5例中，CR／VGPR2例（40％），PR3例（60％）。20例随访3～21个月（平均8个月），16例（72％）持续CR／VGPR／PR（平均10．6月）；4例NR患者接受其他化疗维持。出现的不良反应包括外周神经病变4例、疲乏6例、带状疱疹1例、下肢水肿2例，1例出现轻度皮肤过敏反应，有l例出现不完全性肠梗阻，1例出现血压增高，1例出现血糖增高反应。肾功能不全患者可安全使用，并同样有效。结论中西医结合治疗多发性骨髓瘤疗效确切，可缓解症状，起到减毒增效作用。

Objective To observe the therapeutic effects and side effects of of treating primary or recurrent multiple myeloma with combined treatment of traditional Chinese medicine and western medicine Bortezomib. Methods 22 cases of multiple myeloma were treated with with combined treatment of traditional Chinese medicine and western medicine Bortezomib. The patients were classifiesd into two types： turbid phlegm and blood stasis and liver - kidney deficiency, then determined the treatment based on differentiation of symptoms and signs. From the first day of chemotherapy, Chinese drugs were administered once a day, it was decocted to 200ml and given half the doze once in the morning and once at night. The Bortezomib was iv injected 1.0 - 1.3mg/m2, on 1th,4th,8th and 11th day and 3 weeks was a cycle. All the patients had l - 5 cycles of treatment. The clinical effects and observation were observed. Results 11 cases of VGPR/CR（50% ） ,PR in 7cases（33% ） ,total effect rate was 83%. Among the 5 cases which finished 2 cycles and could be evaluated： the CR/VGPR was 2 （40%） , PR 3 （60%）. 20 cases were followed for 3 -21 months（ average 8 months）, 16 ~j （ 72% ） had CR/VGPR/PR （ average 10.6, months）. Four NR patients had other chemotherapy. The side effects included peripheral nerve disease in 4, fatigue in 1, oedema legs in 2, slight skin allergic reaction in 1, incomplete bowl obstruction in 1, hypertension in 1 and high glucose in 1. This is safe and effective for patients with renal failure. Conclusions The therapeutic effects of treating multiple myeloma with combined treatment of traditional Chinese medicine and western medicine is true.