凋亡抑制蛋白生存素在多发性骨髓瘤FVAD方案化疗疗效中的应用

Applied value of apoptosis inhibitory protein survivin in FVAD chemotherapy efficacy for refracto- ry multiple myeloma

目的探讨凋亡抑制蛋白生存素（Survivin）在难治性多发性骨髓瘤（MM）FVAD（氟达拉滨、长春新碱、表阿霉素、地塞米松）方案化疗疗效中的应用价值。方法选取我院住院部MM患者83例，其中初治MM（初治组）43例，采用VAD方案（长春新碱、表阿霉素、地塞米松）化疗，难治MM（难治组）40例，采用FVAD方案化疗，骨髓穿刺采集骨髓片，并采用免疫组织化学方法检测Survivin蛋白表达，比较两组Survivin阳性表达率的差异，分析Survivin表达与FVAD化疗近远期疗效的关系。结果难治组Survivin阳性表达率（72．09％）明显高于初治组（42．50％），两组差异有统计学意义（P〈0．05），Survivin阳性组完全缓解率（4．20％）和治疗有效率（22．92％）均明显低于Survivin阴性组完全缓解率（14．20％）和治疗有效率（57．14％），两组差异有统计学意义（P〈0．05），Survivin阳性组总生存期和无进展生存期均明显低于Survivin阴性组，两组差异有统计学意义（P〈0．05）。结论Survivin蛋白阳性表达在难治性MM组织中显著增高，并预示FVAD方案化疗近远期疗效更差。

Objective To investigate the applied value of apoptosis inhibitory protein Survivin in FVAD （fludarabine, vincristine, epirubicin and dexamethasone） chemotherapy afficay for refractory multi- ple myeloma. Methods Eighty - three cases of multiple myeloma from hematology inpatient department were selected, including 40 cases of initial multiple myeloma （ initial treatment group）, who were given VAD scheme （vincristine, epirubicin, dexamethasone） chemotherapy, and 43 cases of refractory multiple myeloma （refractory group）, who were given FVAD chemotherapy. Bone marrow was collected from mar- row aspiration, and Survivin protein expression was detected by immunohistochemistry. Survival was ana- lyzed using Kaplan - Meier. The difference in Survivin positive expression rate between groups was ana- lyzed, and the relationship between Survivin expressoon and FVAD chemotherapy short - and long - term efficacy was also analyzed. Results The positive Survivin expression rate in refractory group （72.09%） was significantly higher than in initial treatment group （42. 50% ） with significant differences between two groups （P 〈0.05）. Complete remission rate （4. 20% ） and the effective rate （22.92%） in positive Sur- vivin group were significantly lower than those （ 14. 20% and 57. 14% ） in Survivin negative group with differences being significant between two groups （P 〈 0. 05）. Overall survival and progression free survival in Survivin positive group were significantly lower than those in Survivin negative group （P 〈 0. 05）. Con- clusion Survivin protein positive expression increased significantly in refractory multiple myeloma tissue, indicating the short - and long - term curative effectineness of FVAD chemotherapy is worse.