VMDT方案和VAD方案治疗多发性骨髓瘤的疗效比较

Comparison of therapeutic effects of VMDT scheme and VAD scheme treatment of multiple myeloma

目的观察和比较VMDT方案和VAD方案在治疗多发性骨髓瘤的临床疗效和不良反应。方法选择2007年8月~2014年8月我院收治的多发性骨髓瘤患者64例,随机分为两组,VMDT组32例,VAD组32例。分别采用VMDT方案和VAD方案化疗4个疗程,比较两组的临床疗效和不良反应。结果 VMDT组的临床有效率为81.25%,VAD组的临床有效率为56.25%,VMDT组的临床疗效显著优于VAD组,差异具有统计学意义（P〈0.05）。临床的主要指标方面,VMDT组的M蛋白下降50%以上为62.50%,骨髓瘤细胞下降80%以上占62.50%,血红蛋白上升20g/L占56.25%,VAD组M蛋白下降50%以上为50.00%,骨髓瘤细胞下降80%以上占53.13%,血红蛋白上升20g/L占50%,VMDT组显著优于VAD组,差异具有统计学意义（P〈0.05）。在不良反应反面,VMDT组在便秘,疲乏,乏力和肝肾功能损害方面显著优于VAD组（P〈0.05）,在口干,肢体麻木,消化道症状方面,两组比较差异无统计学意义（P〉0.05）。结论相对于传统的VAD方案,VMDT方案更好,使用糖皮质激素量较少,临床有效率更高,副作用较低,且较适合基层医院应用,值得临床推广应用。

Objective To observe and to compare the clinical effect and adverse reaction of VMDT scheme and VAD scheme in the treatment of multiple myeloma. Methods 64 patients with multiple myeloma, who were received and cured in our hospital from August 2007 to August 2014, were selected and randomly divided into VMDT group and VAD group, with 32 cases in each group. To respectively adopt VMDT scheme and VAD scheme with 4 courses of chemotherapy, to compare the clinical effect and adverse reaction between the two groups. Results The clinical effective rate in VMDT group（81.25 % ） was obviously better than which in VAD group（56.25 % ）, the differences was statically significant（P 〈 0.05）. Of the primary clinical index aspect, M protein in VMDT group（62.50%） and in VAD group（50.00%） had declined more than 50%, myeloma cells in VMDT group（62.50%） and in VAD group（53.13%） had declined more than 80%, hemoglobin in VMDT group（56.25%） and in VAD group（50.00%） had risen 20g/L, which in VMDT group was significantly better than which in VAD group, the differences was statically significant （P〈0.05）. The adverse reaction of constipation, fatigue, hypodynamia, function lesion of liver and kidney in VMDT group was siginificantly better than which in VAD group（P〈0.05）, the adverse reaction of dry mouth, limb numbness, digestive tract symptom in VMDT group was no statistical significance （P 〉 0.05）. Conclusion VMDT scheme is much better than conventional VAD scheme with lesser glucocorticoid, has higher clinical effective rate and lower side effect, is applied compatibly in primary hospital, and is worthy of clinical popularization and application.