黄连解毒汤对多发性骨髓瘤患者外周血Th1/Th2平衡及周围神经病变的影响

Effect of Huanglian Jiedu Decoction on the Th1/Th2 Balance in Peripheral Blood and Peripheral Neuropathy in Patients with Multiple Myeloma

目的:观察黄连解毒汤联合低剂量沙利度胺治疗多发性骨髓瘤(multiple myeloma,MM)的临床疗效及对患者外周血Th1/Th2平衡、周围神经病变的影响。方法:114例MM患者按照随机数字表法分成观察组和对照组,每组各57例。两组均给予VAD方案(长春新碱+阿霉素+地塞米松)化疗,对照组在此基础上给予低剂量沙利度胺(每次100 mg,每日1次)治疗,观察组在对照组治疗基础上给予黄连解毒汤治疗。所有患者均治疗4个化疗周期。比较两组患者临床疗效,治疗前后血清M蛋白浓度、骨髓浆细胞占比、辅助性T细胞(Th1/Th2)细胞因子[γ干扰素(interferon-γ,IFN-γ)、白细胞介素-10(interleukin-10,IL-10)及Th1/Th2(即IFN-γ/IL-10)]水平变化,周围神经病变(peripheral neuropathy,PN)发生情况。结果:观察组有效率为89.47%(51/57),对照组有效率为73.68%(42/57),两组比较,差异有统计学意义(P<0.05)。两组患者治疗后血清M蛋白浓度和骨髓浆细胞占比均显著低于治疗前(P<0.05),且观察组降低更显著(P<0.05)。两组治疗后血清IFN-γ浓度及Th1/Th2比值均较治疗前明显升高(P<0.05),而IL-10含量则明显降低(P<0.05);且观察组改善更显著(P<0.05)。观察组PN发生率为35.09%(20/57),对照组PN发生率为54.39%(31/57),两组比较,差异有统计学意义(P<0.05)。结论:黄连解毒汤联合低剂量沙利度胺治疗MM疗效显著,能有效维持患者机体Th1/Th2细胞平衡,减少PN的发生。

Objective:To observe the clinical effect of Huanglian Jiedu Decoction combined with low-dose thalidomide in the treatment of multiple myeloma(MM)and its effect on the balance of Th1/Th2 in peripheral blood and peripheral neuropathy.Methods:114 MM patients were randomly divided into the observation group and the control group according to the random number ta-ble method,each group has 57 cases.Both groups were given VAD regimen(vincristine+adriamycin+dexamethasone)chemotherapy,the control group was given low-dose thalidomide(100 mg/time,once a day)treatment,and the observation group was given Huanglian Jiedu Decoction Treatment on the basis of the control group.All patients were treated with 4 chemotherapy cycles.The clinical effects of the two groups were compared.Before and after treatment,the serum M protein concentration,the proportion of bone marrow plasma cells,the level of helper T cell(Th1/Th2)cytokines[(interferon-γ(IFN-γ),interleukin-10(IL-10)and Th1/Th2 ratio(IFN-γ/IL-10)]and the occurrence of peripheral neuropathy(PN)were compared.Results:The effective rate was 89.47%(51/57)in the observation group and 73.68%(42/57)in the control group.The difference was statistically significant(P<0.05).The concentration of serum M protein and the proportion of marrow plasma cells in the two groups were significantly lower than those before treatment(P<0.05),and the observation group was significantly lower(P<0.05).The serum IFN-γconcentration and Th1/Th2 ratio of the two groups after treatment were significantly higher than those before treatment(P<0.05),while the IL-10 content was significantly lower(P<0.05),and the improvement of the observation group was more signifi-cant(P<0.05).The incidence of PN was 35.09%(20/57)in the observation group and 54.39%(31/57)in the control group.There was significant difference between the two groups(P<0.05).Conclusion:Huanglian Jiedu Decoction combined with low-dose thalidomide has a significant therapeutic effect on MM,which can effectively maintain the balance of Th1/Th2 cells in patients and reduce the occurrence of PN.