多种治疗对多发性骨髓瘤患者凝血功能的影响

Effects of multiple treatment on blood coagulation of multiple myeloma patients

目的:探索多发性骨髓瘤患者疾病进展及治疗过程中凝血功能变化,以及硼替佐米、沙利度胺、来那度胺、参芎葡萄糖注射液等治疗对多发性骨髓瘤患者凝血功能的影响。方法:回顾性分析464例多发性骨髓瘤患者临床资料和凝血功能结果,根据进程分初治、缓解、进展组;根据治疗分硼替佐米、来那度胺、沙利度胺、硼替佐米联合沙利度胺及参芎组。比较各组患者凝血功能的改变。结果:D-二聚体>500 ng/mL患者在初治、缓解、进展组中分别占41%、25%、33%,差异有统计学意义(P<0.05)。使用硼替佐米患者,治疗后凝血酶时间(TT)延长(P<0.05);使用来那度胺患者,化疗后凝血酶原时间(PT)缩短(P<0.05);使用沙利度胺的患者,血浆纤维蛋白原(FIB)升高(P<0.05)。使用硼替佐米联合沙利度胺患者D-二聚体下降(P<0.05);使用参芎葡萄糖注射液患者治疗后PT较前延长(P<0.05)。以沙利度胺为基础的治疗后FIB升高(P<0.05)。硼替佐米和沙利度胺治疗后D-二聚体下降(P<0.05)。参芎葡萄糖注射液治疗后,PT较治疗前延长(P<0.05)。结论:多发性骨髓瘤患者在疾病进展中常出现高凝状态。硼替佐米及硼替佐米联合沙利度胺在治疗多发性骨髓瘤时,对本病有良好的控制作用。沙利度胺及来那度胺在治疗中使患者易出现高凝状态。参芎葡萄糖注射液的使用在一定程度上可以缓解高凝状态。

Objective:To explore the changes of blood coagulation function in the progression and treatment of multiple myeloma(MM) patients,and the effects of bortezomib,thalidomide,lenalidomide,and Shenxiong glucose injection on the coagulation function of patients with multiple myeloma.Methods:We investigated 464 MM patients,and collected their clinical data and blood coagulation results.The blood coagulation indices were compared by using SPSS 19.0.Results:The patients with serum D-dimer>500 ng/mL accounted for 41%,25%,and 33%,respectively,in the newly diagnosis,remission,and progression groups,with significant difference(P<0.05).It was founded that thrombin time(TT) significantly prolonged after administrating of bortezomib-based therapy(P<0.05).Prothrombin time(PT) was shortened after using lenalidomide-based therapy(P<0.05).Fibrinogen(FIB) increased after using thalidomide-based therapy(P<0.05).D-dimer levels were decreased in patients treated with bortezomib and thalidomide(P<0.05).After Shenxiong glucose injection treatment,PT was longer than before(P<0.05).Conclusion:Hypercoagulable state often occurs in the development of MM.Bortezomide and its combination with thalidomide showed some circulatory improvement in the treatment of multiple myeloma.Both thalidomide and lenalidomide could increase the risk of hypercoagulability of MM patients.The application of Shenxiong glucose injection may alleviate the hypercoagulability to some extent.