沙利度胺联合伊曲康唑治疗多发性骨髓瘤合并肺部感染的临床疗效观察

Clinical efficacy of thalidomide combined with itraconazole for multiple myeloma complicated with pulmonary infection

目的探究沙利度胺联合伊曲康唑治疗多发性骨髓瘤合并肺部感染的临床疗效。方法选取2013年3月至2016年12月间广东省东莞市人民医院收治的50例多发性骨髓瘤合并肺部感染患者,采用随机数字表法分为观察组与对照组,每组25例。对照组患者服用沙利度胺片治疗,观察组患者在对照组基础上联合伊曲康唑治疗。比较两组患者临床疗效;测量两组患者治疗前后血清中M蛋白比例、骨髓浆细胞比例、血红蛋白含量、肿瘤坏死因子α(TNF-α)及生长因子(VEGF)含量;统计两组患者治疗期间不良反应发生情况。结果观察组患者临床总有效率为100.0%,显著优于对照组患者的84.0%,差异有统计学意义(P<0.05)。两组患者治疗前,血清中M蛋白比例、骨髓浆细胞比例及血红蛋白含量比较,无显著性差异;治疗后,观察组患者血清中M蛋白比例及骨髓浆细胞比例显著下降,血红蛋白含量显著升高,且与对照组相比,差异均有统计学意义(均P<0.05)。两组患者治疗前,血清中TNF-α及VEGF含量无显著性差异;治疗后,观察组患者血清中TNF-α及VEGF含量显著下降,且与对照组相比,差异均有统计学意义(均P<0.05)。两组患者治疗期间均未发生严重不良反应。结论沙利度胺联合伊曲康唑治疗多发性骨髓瘤合并肺部感染,临床效果显著,安全性良好,能够显著减少患者血清TNF-α及VEGF含量,值得推广。

Objective To investigate the clinical efficacy of thalidomide combined with itraconazole in the treatment of multiple myeloma complicated with pulmonary infection. Methods From March 2013 to December 2016, 50 patients with multiple myeloma complicated with pulmonary infection treated at Peopleg Hospital of Dongguan were enrolled in this study and were randomly divided into an observation group and a control group with 25 patients in each group. Besides thalidomide, patients in the observation group were given itraconazole and patients in the control group were only given thalidomide. The clinical efficacy was compared between the two groups. Proportion of M protein, the content of bone marrow plas- ma cells and hemoglobin content, Tumor necrosis factor alpha （TNF-a） and vascular endothelial growth factor （VEGF） were measured in both groups. The incidence of adverse events was recorded between the two groups of patients during treatment. Results The overall efficacy rate was 100. 0% for the observa- tion group, which was significantly better than 84.0% of the control group. No statistically significant difference was noted in the proportion of M protein, the content of bone marrow plasma cells and hemoglo- bin content between the two groups before the treatment （ P 〉 0. 05 ）. After treatment, the proportion ofserum M protein and the ratio of bone marrow plasma ceils significantly decreased and the levels of hemo- globin increased in the observation group （ all P 〈 0. 05 ）. Before the treatment, there was no significant difference in serum TNF-a and VEGF levels between the two groups （ P 〉 0. 05 ）. After treatment, levels of TNF-a and VEGF significantly decreased in the observation group （ all P 〈 0. 05 ）. Conclusion The efficacy of thalidomide combined with itraconazole in the treatment of multiple myeloma complicated with pulmonary infection is significant and safe and it can significantly reduce serum TNF-a and VEGF levels and is worthy of clinical popularization.