椎体成形术联合放疗治疗多发性骨髓瘤椎体转移性疼痛的临床疗效评价

Clinical evaluation of vertebroplasty combined with radiotherapy in the treatment of multiple myeloma vertebral metastatic pain

目的评价放疗联合椎体成形术治疗多发性骨髓瘤椎体转移性疼痛的临床疗效。方法回顾性选取2020年2月至2021年2月唐山市人民医院收治的多发性骨髓瘤椎体转移性疼痛患者60例,依据治疗方法分为放疗联合椎体成形术治疗(联合治疗组)和单纯椎体成形术治疗(单纯椎体成形术组)两组,每组各30例。统计分析两组患者的血清炎症因子[白细胞介素(IL)-2和IL-4、IL-6、IL-10、IL-17、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平、免疫功能、疼痛程度、健康状况、临床疗效、并发症发生情况及患者的治疗满意度。结果联合治疗组患者的血清IL-4、IL-6、IL-10、IL-17、TNF-α、CRP、CD8^(+)、IgA、IgE、NRS评分分别为(16.80±2.31)pg/mL、(33.36±4.24)ng/L、(21.42±3.71)pg/mL、(3.14±0.36)pg/mL、(60.28±5.10)pg/mL、(24.96±3.23)mg/L、(27.04±3.62)%、(0.84±0.10)g/L、(182.32±11.53)IU/mL、(2.36±0.30)分,均明显低于单纯椎体成形术组[(48.62±4.32)pg/mL、(38.16±4.10)ng/L、(55.14±10.15)pg/mL、(1.42±0.22)pg/mL、(89.74±5.14)pg/mL、(39.77±3.50)mg/L、(30.15±3.28)%、(1.00±0.10)g/L、(300.44±14.27)IU/mL、(5.18±0.62)分],IL-2、IFN-γ、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IgG、IgM水平、KPS评分分别为(4.52±1.10)pg/mL、(89.75±14.34)pg/mL、(57.72±2.82)%、(37.27±3.23)%、1.40±0.26、(11.15±1.30)g/L、(1.62±0.24)g/L、(74.48±7.23)分,均高于单纯椎体成形术组[(2.40±0.32)pg/mL、(36.23±6.26)pg/mL、(54.23±2.80)%、(34.73±3.52)%、1.15±0.16、(9.41±1.24)g/L、(1.20±0.20)g/L、(69.86±6.47)分],差异均有统计学意义(P<0.05)。联合治疗组患者的总缓解率为86.67%,明显高于单纯椎体成形术组(63.33%),差异有统计学意义(P<0.05)。联合治疗组患者的并发症发生率为10.00%,与单纯椎体成形术组(3.33%)相比,差异无统计学意义(P>0.05)。联合治疗组患者的治疗满意度为93.33%,明显高于单纯椎体成形术组(66.67%),差异有统计学意义(P<0.05)。结论放疗联合椎体成形术治疗多发性骨髓瘤椎体转移性疼痛的临床疗效优于单纯椎体成形术治疗,更能有效降低患者的血清炎症因子水平,提升其免疫功能,减轻其疼痛程度,改善其健康状况,患者满意度高。

Objective To evaluate the clinical efficacy of radiotherapy combined with vertebroplasty in the treatment of multiple myeloma vertebral metastatic pain.Methods A total of 60 patients with vertebral metastatic pain from multiple myeloma in Tangshan People's Hospital from February 2020 to February 2021 were retrospectively selected and divided into radiotherapy combined with vertebroplasty treatment group(combined treatment group)and vertebroplasty alone treatment group according to the treatment method,with 30 cases in each group.The levels of serum inflammatory factors[interleukin(IL)-2 and IL-4,IL-6,IL-10,IL-17,interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)],immune function,pain degree,health status,clinical efficacy,complications and treatment satisfaction were statistically analyzed between the two groups.Results The levels of IL-4,IL-6,IL-10,IL-17,TNF-α,CRP,CD8^(+),IgA,IgE and NRS score in the combined treatment group were(16.80±2.31)pg/mL,(33.36±4.24)ng/L,(21.42±3.71)pg/mL,(3.14±0.36)pg/mL,(60.28±5.10)pg/mL,(24.96±3.23)mg/L,(27.04±3.62)%,(0.84±0.10)g/L,(182.32±11.53)IU/mL,(2.36±0.30),which were significantly lower than those in the vertebroplasty group[(48.62±4.32)pg/mL,(38.16±4.10)ng/L,(55.14±10.15)pg/mL,(1.42±0.22)pg/mL,(89.74±5.14)pg/mL,(39.77±3.50)mg/L,(30.15±3.28)%,(1.00±0.10)g/L,(300.44±14.27)IU/mL,(5.18±0.62)points],the levels of IL-2,IFN-γ,CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IgG,IgM and KPS score were(4.52±1.10)pg/mL,(89.75±14.34)pg/mL,(57.72±2.82)%,(37.27±3.23)%,1.40±0.26,(11.15±1.30)g/L,(1.62±0.24)g/L,(74.48±7.23)points,which were significantly higher than those in the vertebroplasty treatment group alone[(2.40±0.32)pg/mL,(36.23±6.26)pg/mL,(54.23±2.80)%,(34.73±3.52)%,1.15±0.16,(9.41±1.24)g/L,(1.20±0.20)g/L,(69.86±6.47)points],the differences were statistically significant(P<0.05).The overall remission rate of the combined treatment group was 86.67%,which was higher than that of the vertebroplasty alone treatment group(63.33%),the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(10.00%and 3.33%)(P>0.05).The treatment satisfaction of patients in the combined treatment group was 93.33%,which was higher than that in the vertebroplasty alone treatment group(66.67%),the difference was statistically significant(P<0.05).Conclusion Radiotherapy combined with vertebroplasty in the treatment of multiple myeloma vertebral metastatic pain is more effective than vertebroplasty alone,which can effectively reduce the level of serum inflammatory factors,improve the immune function of patients,reduce the pain degree of patients,improve the health status of patients,with high patient satisfaction.