中医定向透药疗法联合穴位贴敷对硼替佐米治疗多发性骨髓瘤致神经毒性反应分度的影响

Influence of TCM Directional Penetrating Therapy combined with Acupoint Application on the Neurotoxicity Degree of Bortezomib in the Treatment of Multiple Myeloma

目的:分析中医定向透药疗法联合穴位贴敷对硼替佐米治疗多发性骨髓瘤(MM)致神经毒性反应分度的影响。方法:选取2019年1月~2021年12月本院收治的MM硼替佐米治疗后发生神经毒性反应者120例,根据治疗方案进行分组:甲钴胺口服治疗63例(对照组)、中医定向透药疗法联合穴位贴敷+甲钴胺口服(治疗组)57例。对比两组治疗前后神经毒性反应分度变化、中医证候评分变化及不良反应,同时观察治疗前后两组神经传导速度,观察指标包括双侧腓总神经、胫神经的运动神经传导速度(MNCV),以及腓浅神经的觉神经传导速度(SNCV)。结果:治疗前,两组间神经毒性反应分级比较,差异无统计学意义(P>0.05)。治疗后,两组经毒性反应分级出现下降,治疗组治疗后神经毒性反应分级改善情况优于对照组(Z=-2.753,P=0.006)。治疗前两组中医证候评分比较均无差异(P>0.05),治疗后两组各评分较之前均改善,治疗组患者肢体麻木、肢体疼痛、感觉障碍、肢体冷感评分均低于对照组(P<0.05)。治疗前两组神经传导速度比较并无差异(P>0.05),治疗后两组腓浅神经SNCV、腓总神经/胫神经MNCV值均较之前增高,治疗组治疗后神经传导速度均比对照组快(P<0.05)。对照组不良反应为6.35%,治疗组为1.75%,两组不良反应比较并无差异(P>0.05)。结论:中医定向透药疗法联合穴位贴敷对硼替佐米治疗MM致神经毒性反应具有一定优势,可改善患者临床症状,提高神经传导速度,安全性尚可。

Objective:To analyze the effect of TCM directional penetrating therapy combined with acupoint application on the severity of neurotoxicity induced by bortezomib in the treatment of multiple myeloma(MM).Methods:AFrom January 2019to December 2021,120patients with neurotoxicity after MM bortezomib treatment in our hospital were selected and divided into two groups according to the treatment plan:63patients were treated with oral mecobalamin(control group),while 57patients were treated with TCM directional penetration therapy combined with acupoint application+oral administration of methylcobalamin(treatment group).The changes of neurotoxicity grades,TCM symptom scores and adverse reactions were compared between the two groups before and after treatment.At the same time,the nerve conduction velocity of the two groups before and after treatment was observed,and the observation indicators included the motor nerve conduction velocity(MNCV)of the bilateral common peroneal nerve and the tibial nerve,the sensory nerve conduction velocity(SNCV)of the superficial peroneal nerve.Results:Before treatment,there was no significant difference in the grades of neurotoxicity between the two groups(P>0.05).After treatment,the toxicity grades in the two groups decreased,and the improvement of neurotoxicity grades in the treatment group was better than that in the control group(Z=-2.753,P=0.006).Before treatment,there was no difference in TCM symptom scores between the two groups(P>0.05).After treatment,the scores of the two groups were improved compared with before,and the scores of limb numbness,limb pain,sensory disturbance and limb coldness in the treatment group were all lower than those in the control group(P<0.05).There was no difference in nerve conduction velocity between the two groups before treatment(P>0.05).After treatment,the SNCV of superficial peroneal nerve and the MNCV of common peroneal nerve/tibial nerve in the two groups were higher than those before treatment.After treatment,the nerve conduction velocity of the treatment group was faster than that of the control group.(P<0.05).The adverse reactions were 6.35%in the control group and 1.75%in the treatment group,and there was no difference between the two groups(P>0.05).Conclusion:The combination of TCM directional penetration therapy and acupoint application has certain advantages in the treatment of neurotoxic reaction to MM with bortezomib,which can improve patients'clinical symptoms and nerve conduction velocity with fair safety.