多发性骨髓瘤伴高黏滞综合征和肾功能损害患者行血浆置换术序贯化疗临床观察  

Plasma exchange followed by chemotherapy treatment for multiple-myeloma patients with high viscosity syndrome and renal dysfunction: a clinical analysis

作　　者：高菲[1] 王佳[1] 欧焘[1] 谢万春[1] 

机构地区：[1]内江市第二人民医院血液科,四川内江641000

出　　处：《中国输血杂志》2017年第7期708-710,共3页Chinese Journal of Blood Transfusion

摘　　要：目的探讨血浆置换术(PE)序贯化疗对多发性骨髓瘤(MM)伴高黏滞综合征和肾功能损害患者的近期疗效。方法收集20例多发性骨髓瘤伴高黏滞综合征和不同程度肾功能损害病例,随机均分为PE联合化疗组(PE+化疗组):使用血细胞分离机行PE,置换3次/[(2 600±580)m L/次、间隔1 d]后序贯VAD方案(长春新碱0.5 mg持续静脉滴注12 h,阿霉素10 mg持续静脉滴注12 h,地塞米松40 mg qd1-4)化疗;单纯化疗组(对照组):患者接受标准VAD方案治疗。比较2组在2周期治疗前后的球蛋白(GLB)、血沉(ESR)、血液流变学指标等指标。结果高黏滞综合征相关症状龈血/鼻衄,头昏和肢端麻木,PE+化疗组较对照组有明显改善(P<0.05);治疗前及治疗后PE+化治疗组、对照组GLB(g/L)分别为80.0±19.6 vs 30.0+10.5,85.5±21.5 vs 53.5±16.0(P<0.05);Cr(μmol/L)分别为359.0±30.5 vs 105.0±25.0,362.0±39.6 vs 190.0±43.0(P<0.05);ESR(mm/h)分别为80.0±22.5 vs 12±0.6,83.0±23.6 vs 30.0±3.6(P<0.05);血液流变学指标全血还原粘度(m Pa/s)高切分别为16.2±2.1vs 8.5±0.6,15.8±2.0 vs 12.8±0.8(P<0.05),中切分别为19.0±0.5 vs 10.8±0.6,20.0±0.6 vs 15.2±0.8(P<0.05),低切分别为50.3±2.9 vs 28.1±1.2,52.7±3.5 vs 40.2±3.5(P<0.05)。结论 MM伴高黏滞综合征和肾功能损害的患者先行PE序贯化疗的近期效果优于单纯化疗。Objective To assess the clinical performance of plasma exchange （ PE ） followed by chemotherapy treatment for muhiplc-myeloma patients with high-viscosity syndrome and renal dysfunction.Methods 20 cases of multiple-myeloma patients with high viscous syndrome and various levels of re- nal dysfunction, were randomly divided into PE-chemotherapy group （the experiment groups） and chemotherapy-only group （the control group）. In the experiment groups, the patients received PE via blood cell separators for 3 times （2 600＋580 mL each time, 1 day interval） followed by VAD regimens chemotherapy （0. 5 mg vincristine continuous intravenous drip for 12 h, adriamycin 10 mg continuous intravenous drip for 12 h and dexamethasone 40 mg qdl-4）. In the control group, patients received standard VAD regimen. After 2 cycles of chemotherapy, globulin （ GLB）, blood sedimentation （ESR） and hemo- rheology properties were compared between the two groups before and after treatment.Results The symptoms of high viscosi- ty syndrome（ gingivial blood/nosebleed, dizziness and extremities numbness）in the treatment group were significantly im- proved compared with that in the control group （P〈0. 05）. Before and after therapy, the GLB （g/L） were 80. 0± 19.6 vs 30. 0±10.5 in the treatment group and 85.5 ±21.5 vs 53.5±16.0 in the control group （P〈 0. 05）, respectively; the Cr （μmol./L） were 359. 0±30. 5 vs 105.0±25.0 and 362. 0±39. 6 vs 190. 0±43.0, respectively（P〈0. 05） ;the ESR （mm/h） were 80.0±22. 5 vs 12＋0.6 and 83.0±23.6 vs 30.0±3.6 （P〈0.05）, respectively;the whole blood high shear reductive viscosity were 16.2±2. 1 vs 8. 5±0. 6 and 15. 8±2. 0 vs 12. 8±0. 8 （P〈0. 05）, respectively;the whole blood middle shear reductive viscosity were 19. 0±0. 5 vs 10. 8±0. 6 and 20. 0±0. 6 vs 15.2±0. 8 （P〈0. 05）, respectively ;the whole blood low shear reductive viscosity were 50. 3±2. 9 vs 28. 1±1.2 and 52. 7±3.5 vs 40. 2±3.5（P〈0. 05）, respectively.

关 键 词：血浆置换 化疗 多发性骨髓瘤 高黏滞综合征 肾功能损害 

分 类 号：R457.14[医药卫生—治疗学] R733.3[医药卫生—临床医学]