硼替佐米联合环磷酰胺及地塞米松治疗多发性骨髓瘤疗效及对患者肾功能指标和不良反应的影响

Efficacy of Bortezomib Combined with Cyclophosphamide and Dexamethasone in the Treatment of Multiple Myeloma and Its Influence on Renal Function Indexes and Adverse Reactions

目的:探讨硼替佐米联合环磷酰胺及地塞米松治疗(VCD方案)多发性骨髓瘤(MM)疗效及对患者肾功能指标和不良反应的影响。方法:采用随机数字表法将112例MM患者随机分为对照组和观察组,每组56例,对照组给予沙利度胺、环磷酰胺和地塞米松联合化疗(CTD方案),观察组给予硼替佐米、环磷酰胺及地塞米松化疗联合(VCD方案),3周为1个疗程,共治疗10个疗程,评定两组治疗后的临床疗效,比较两组治疗前后的血液检验结果、肾功能指标,观察两组不良反应。结果:观察组的临床总有效率可达92.86%,显著高于对照组的71.43%(P<0.05);治疗10个疗程后,两组血清M蛋白含量、骨髓浆细胞比例及血β2微球蛋白(β2-MG)显著低于治疗前(P<0.05),血清血红蛋白(Hb)含量和血小板因子4(PF4)水平显著高于治疗前(P<0.05),观察组变化幅度显著大于对照组(P<0.05);治疗10个疗程后,观察组血清尿素氮(BUN)、肌酐(SCr)、尿酸(UA)水平显著低于治疗前及对照组(P<0.05);两组患者的血小板减少、白细胞减少、中性粒细胞减少、乏力、恶心腹胀及周围神经病变的发生率对比,差异无统计学意义(P<0.05)。结论:硼替佐米联合环磷酰胺及地塞米松治疗MM疗效显著,能有效降低血清M蛋白、骨髓浆细胞比例及β2-MG含量,促进血清Hb含量增加和PF4高水平表达,能对早期肾功能损害起到预防和改善作用,毒副反应较轻,临床安全性较佳。

Objective:To investigate the efficacy of bortezomib combined with cyclophosphamide and dexamethasone(VCD regimen)in the treatment of multiple myeloma(MM)and its influence on renal function indexes and adverse reactions.Methods:112 patients with MM were randomly divided into control group and observation group according to the random number table method,with 56 cases in each group.Control group was given thalidomide,cyclophosphamide and dexamethasone chemotherapy(CTD regimen),and observation group was given bortezomib,cyclophosphamide and dexamethasone chemotherapy(VCD regimen),and they were treated for 10 courses by taking 3 weeks as a course of treatment.The clinical efficacy of the two groups was evaluated and the blood test results and renal function indexes were compared between the two groups before and after treatment,and the adverse reactions were observed in the two groups.Results:The total clinical effective rate in observation group was significantly higher than that in control group(92.86%vs 71.43%)(P<0.05).After 10 courses of treatment,the serum M protein content,bone marrow plasma cell ratio and bloodβ2 microglobulin(β2-MG)of the two groups were significantly lower than those before treatment(P<0.05)while the levels of serum hemoglobin(Hb)and platelet factor 4(PF4)were significantly higher than those before treatment(P<0.05),and the changes in observation group were significantly more than those in control group(P<0.05).After 10 courses of treatment,the levels of blood urea nitrogen(BUN),serum creatinine(SCr)and uric acid(UA)in observation group were significantly lower than those before treatment and those in control group(P<0.05).There were no statistically significant differences in the incidence rates of thrombocytopenia,leukocytopenia,neutropenia,fatigue,nausea and abdominal distension and peripheral neuropathy between the two groups(P<0.05).Conclusion:Bortezomib combined with cyclophosphamide and dexamethasone has a significant efficacy in the treatment of MM.It can effectively reduce the serum M protein,bone marrow plasma cell ratio andβ2-MG,and promote the increase of serum Hb content and high-level expression of PF4.And it can play a preventive and ameliorating role in early renal function damage,with mild toxic and side effects and better clinical safety.