VRD与PCD方案治疗多发性骨髓瘤患者的效果及对细胞免疫指标、远期生存情况的影响对比

Comparison of the Effect of VRD and PCD in the Treatment of Multiple Myeloma Patients and the Influence on Cellular Immune Indexes and Long-Term Survival

目的探讨硼替佐米、来那度胺联合地塞米松(VRD)与硼替佐米、环磷酰胺联合地塞米松(PCD)方案治疗多发性骨髓瘤(MM)患者的临床效果。方法选取2020年1月—2022年12月金乡县人民医院收治的78例MM患者为研究对象,按随机数字表法将其分为对照组和观察组,各39例。对照组行PCD方案化疗,观察组行VRD方案化疗。比较两组患者的临床疗效、血清生化指标、细胞免疫指标、远期生存情况及不良反应发生情况。结果观察组疾病控制率为94.87%,高于对照组的79.49,差异有统计学意义(P<0.05)。治疗后,观察组M蛋白、骨髓浆细胞分别为(2.82±0.38)g/L、(4.32±0.45)%,均低于对照组的(4.05±0.42)g/L、(5.88±0.79)%,组间差异有统计学意义(P<0.05);观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、Treg分别为(67.52±5.51)%、(43.24±4.12)%、(1.86±0.25)、(4.85±0.45)%,均高于对照组的(62.34±5.42)%、(39.54±3.87)%、(1.72±0.23)、(4.31±0.42)%,组间差异有统计学意义(P<0.05)。观察组远期生存率与静脉血栓发生率分别为89.74%、20.51%,均高于对照组71.79%、5.13%,组间差异有统计学意义(P<0.05)。结论VRD治疗MM效果更佳,可更好调节患者细胞免疫指标,降低M蛋白、骨髓浆细胞水平,提高远期存活率,但静脉血栓发生风险高,需斟酌应用。

Objective To investigate the clinical efficacy of bortezomib,lenalidomide combined with dexamethasone(VRD)and bortezomib,cyclophosphamide combined with dexamethasone(PCD)in the treatment of multiple myeloma(MM)patients.Methods A total of 78 MM patients admitted to Jinxiang County People's Hospital from January 2020 to December 2022 were selected as the research objects and divided into a control group and an observation group according to random number table method,with 39 cases in each group.The control group received PCD chemotherapy,and the observation group received VRD chemotherapy.The clinical efficacy,serum biochemical indicators,cellular immune indicators,long-term survival and occurrence of adverse reactions were compared between the two groups.Results The disease control rate of the observation group was 94.87%,which was higher than 79.49% of the control group,and the difference was statistically significant(P<0.05).After treatment,the M protein and bone marrow plasma cells in the observation group were(2.82±0.38)g/L and(4.32±0.45)%,respectively,which were lower than(4.05±0.42)g/L and(5.88±0.79)%in the control group,and the differences between the groups were statistical significance(P<0.05);CD3^(+),CD4^(+),CD4^(+)/CD8^(+)and Treg were(67.52±5.51)%,(43.24±4.12)%,(1.86±0.25)and(4.85±0.45)%in the observation group,respectively,which were higher than(62.34±5.42)%,(39.54±3.87)%,(1.72±0.23)and(4.31±0.42)% in the control group,and the differences between the groups were statistically significant(P<0.05).The long-term survival rate and incidence of venous thrombosis in observation group were 89.74% and 20.51%,respectively,which were higher than 71.79% and 5.13% in the control group,and the difference between the groups were statistical significance(P<0.05).Conclusion VRD is more effective in the treatment of MM,which can better regulate the cellular immune indexes of patients,reduce the levels of M protein and bone marrow plasma cells,and improve the long-term survival rate.However,the risk of venous thrombosis is high,and the application should be considered.