初治多发性骨髓瘤合并肾功能不全的临床治疗  

Clinical management of renal failure in newly diagnosed multiple myeloma

作　　者：陆米则[1] 司淑平[1] 蒋元强[1] 陈亨[1] 庄芸[1] 孙鸿丽[1] 孙超[1] 沈云峰[1] 

机构地区：[1]无锡市人民医院血液病科,214000

出　　处：《江苏医药》2010年第15期1773-1775,共3页Jiangsu Medical Journal

摘　　要：目的探讨大剂量地塞米松为主方案治疗初治多发性骨髓瘤(MM)合并肾功能不全(RF)的临床疗效。方法回顾性分析40例初治MM合并RF的临床资料,大剂量地塞米松为主方案(A组)22例,加用沙利度胺和(或)硼替唑咪(B组)18例。结果化疗总有效(部分加完全缓解)率50.0%,两组无明显差异(P>0.05)。肾功能逆转者对化疗有效率高于不可逆者(P<0.05);两组肾功能逆转率无差异(P>0.05),但B组肾功能逆转快(P<0.01)。多因素分析示,血肌酐(Cr)是肾功能可逆性的独立预测因素。结论大剂量地塞米松为主方案联合沙利度胺和(或)硼替唑咪,可加快肾功能逆转。血Cr是肾功能可逆性的独立预测因素。Objective To investigate the clinical efficacy of high dose dexamethasone-predominant regimens in newly diagnosed patients with multiple myeloma（MM） and renal failure（RF）.Methods Medical records of 40 patients with MM and RF newly diagnosed were reviewed.Of 40 patients,22 cases（given A） were given the regimen of high dose dexamethasone and 18 cases（given B） were given additional thalidomide and/or bortezomib.Results The overall response rate（complete remission and partial remission） to chemotherapy were 50.0% and there were no significant defferences between two groups（P〉0.05）.The effective rate of response to the treatment was higher in the patients who achieved renal function reversal than those who did not（P〈0.05）.There was no significant difference in the rate of RF reversal in two groups（P〉0.05）.However,the median time to RF reversal was shorter in group B than that in group A （P〈0.01）.Logistic regression multivariate analysis showed that serum creatinine level was associated with renal function recovery.ConclusionThe addition of thalidomide and/or bortezomib to high dose dexamethasone induces a more rapid renal function reversal.Serum creatinine level is an independent factor associated with renal function recovery.

关 键 词：地塞米松 肾功能不全 骨髓瘤 沙利度胺 硼替佐米 

分 类 号：R551[医药卫生—血液循环系统疾病]