以硼替佐米为基础的联合方案治疗114例初诊多发性骨髓瘤患者的周围神经病变分析  

Analysis of peripheral neuropathy following treatment with bortezomib in 114 newly-diagnosed multiple myeloma patients

作　　者：曹亚峰 王静 顾俊 陆弘逾 许杰 刘元坊 王焰[2] 王瑾[2] 陈钰 陈玉宝 李佳明 郝杰 糜坚青[2] 陈梅 

机构地区：[1]同济大学附属杨浦医院血液科,上海200090 [2]上海交通大学医学院附属瑞金医院血液科,上海200025 [3]上海交通大学医学院附属瑞金医院北院血液科,上海201801 [4]上海市北站医院血液科,上海200070

出　　处：《诊断学理论与实践》2017年第5期492-497,共6页Journal of Diagnostics Concepts & Practice

摘　　要：目的:观察、分析初次诊断多发性骨髓瘤(multiple myeloma,MM)患者采用硼替佐米为基础的联合化疗方案治疗后其周围神经病变情况。方法:收集2008年9月至2017年5月在上海交通大学医学院附属瑞金医院、上海交通大学医学院附属医院瑞金北院、上海市北站医院及同济大学附属杨浦医院血液科接受硼替佐米为基础的化疗方案治疗的初诊为MM的114例患者。根据治疗效果分为3组,组(1)为完全缓解(complete remission,CR)患者+很好的部分缓解(very good partial response,VGPR)患者,共60例;组(2)为部分缓解(partial remission,PR)患者,共20例;组(3)为疾病稳定(stable disease,SD)患者+疾病进展(progressive disease,PD)患者,共34例,统计患者接受4个疗程治疗后的周围神经病变发生、相关风险因素分析及后续改善情况。结果:周围神经病变的总体发生率为65.8%,组(1)发生神经病变者49例、组(2)13例、组(3)13例。4个疗程中,若患者出现周围神经病变后则调整治疗方案,调整后的单个疗程的硼替佐米总剂量,利用Kruskal-Wallis秩和检验方法进行统计,发现组(1)、组(2)、组(3)的硼替佐米剂量差异有统计学意义(P=0.002),不同疗效组间的周围神经病变程度差异存在统计学意义(P=0.042);利用Spearman方法分析发现疗效与周围神经病变间呈负相关(r=-0.383,P=0.001)。Spearman法分析结果显示,MM患者疗效与初诊时β2微球蛋白、乳酸脱氢酶水平呈负相关(r均<-0.3,P<0.05);周围神经病变的出现与初诊时的白蛋白、β2微球蛋白、血钙、血红蛋白、血小板、肌酐、乳酸脱氢酶、性别、年龄间无统计学相关性(r均<0.3,P>0.05)。加用维生素B12治疗后,能够改善其周围神经病变(P=0.032)。结论:初治MM患者在采用硼替佐米为基础的方案治疗时早期出现神经病变,即预示其有较高的治疗反应率;该种周围神经病变的发生与白蛋白、β2微球蛋白、血钙、血红蛋白、血小�Objective： To investigate the occurrence and development of bortezomib-induced peripheral neuropathy in newly-diagnosed multiple myeloma （MM） patients. Methods： A total of 114 newly-diagnosed MM patients receiving bortezomib based therapeutic regimen at Ruijin Hospital, Ruijin Hospital Northern Branch, Shanghai North Station Hospital and Yangpu Hospital from September 2008 to May 2017 were enrolled. According to treatment response, patients were divided into three groups： Group 1, complete remission （CR） and very good partial response （VGPR）, 60 cases; Group 2, partial remission （PR）, 20 cases; Group 3, stable disease （SD） and progressive disease （PD）, 34 cases. The incidence, influencing factors and subsequent improvement of peripheral neuropathy （PN）after 4 treatment cycles were analyzed. Results： The overall incidence of peripheral neuropathy was 65.8%; and there were 49 cases（43.0%） in group 1, 13 cases （11.4%） in group 2 and 13 cases （11.4%） in group 3. During the 4 treatment cycles, the dose of bortezomib would be regulated if peripheral neuropathy occurred. Dose of bortezomib was compared between 3 groups by using Kruskal-Wallis test, which revealed that there was significant difference in bortezomib dose and efficacy between the 3 groups （P〈0.05）. Efficacy of bortezomib was negatively correlated with peripheral neuropathy. Univariate analysis showed that albumin, beta-2 microglobulin, calcium, hemoglobin, platelets, creatinine, lactate dehydrogenase,sex and age were not the risk factors for peripheral neuropathy （correlation coefficient 〈0.3）. Peripheral neuropathy could be ameliorated when patients were given Vitamin B12 （P〈0.05）. Conclusions： For newly-daignosed MM patients, the occurrence of PN in the early treatment predicts a better treatment response to bortezomib based therapeutic regimen. Efficacy of bortezomib is negatively correlated with peripheral neuropathy in newly-diagnosed MM patients. The levels of albumin, beta-2 microgl

关 键 词：多发性骨髓瘤 初次诊断 硼替佐米 疗效 周围神经病变 

分 类 号：R551.3[医药卫生—血液循环系统疾病]