不同化疗方案对MM病人血清胱抑素C水平的影响  

EFFECT OF DIFFERENT CHEMOTHERAPY REGIMENS ON SERUM CYSTATIN C LEVEL IN MULTIPLE MYELOMA PATIENTS

作　　者：栗桂环 刘竹珍[1] 李广伦[1] LI Guihuan;LIU Zhuzhen;LI Guanglun(Hematology Department, The Affiliated Hospital of Qingdao University, Qingdao 266003, Chin)

机构地区：[1]青岛大学附属医院血液内科,山东青岛266003

出　　处：《青岛大学学报（医学版）》2018年第1期85-88,共4页Journal of Qingdao University(Medical Sciences)

摘　　要：目的通过观察血清胱抑素C水平的变化,探讨BDT新型化疗方案与VADT传统化疗方案在改善多发性骨髓瘤(MM)病人肾功能方面的差异。方法回顾性分析84例确诊的MM病人,其中40例采用BDT化疗方案,44例采用VADT化疗方案。观察化疗前及4个周期化疗后血清胱抑素C、肌酐、尿素氮水平的变化,并进行统计学分析。结果 MM病人化疗前肾功能异常组较肾功能正常组血清胱抑素C水平明显升高(t=6.086,P<0.05);根据ROC曲线下面积,血清胱抑素C水平在评价MM病人肾功能方面较肌酐、尿素氮更灵敏。Ⅰ、Ⅱ期MM病人血清胱抑素C水平比较差异无统计学意义(P>0.05),Ⅲ期病人血清胱抑素C水平较Ⅰ、Ⅱ期显著升高(F=10.046,t=5.836、4.126,P<0.05)。MM病人采用BDT与VADT化疗方案治疗后血清胱抑素C水平均明显下降,且BDT化疗方案组化疗后血清胱抑素C下降程度较VADT化疗方案组更明显(t=6.242,P<0.05)。结论血清胱抑素C为评价MM肾功能的一个灵敏指标;以硼替佐米为主的BDT化疗方案可明显降低MM病人血清胱抑素C水平,对改善肾功能更有优势,可作为合并肾功能不全MM病人的首选化疗方案。Objective To investigate the clinical effect of BDT chemotherapy regimen（bortezomib,dexamethasone,and thalidomide）versus VADT chemotherapy regimen（Changchun VDS,epirubicin,dexamethasone,and thalidomide）in improving the renal function of multiple myeloma（MM）patients by observing the change in serum cystatin C（Cys-C）level. Methods A retrospective analysis was performed for the clinical data of 84 MM patients,among whom 40 were treated with BDT chemotherapy regimen and 44 were treated with VADT chemotherapy regimen.The levels of serum Cys-C,creatinine,and urea nitrogen were observed before chemotherapy and after four cycles of chemotherapy,and a statistical analysis was performed. Results Before chemotherapy,the abnormal renal function group had a significant increase in serum Cys-C level compared with the normal renal function group（t= 6.086,P〈0.05）.According to the area under the receiver operating characteristic curve,serum Cys-C was more sensitive than creatinine and urea nitrogen in evaluating the renal function of MM patients.There was no significant difference in serum Cys-C level between the patients with stageⅠ MM and those with stageⅡ MM（P〉0.05）,and the patients with stageⅢ MM had a significantly higher serum Cys-C level than those with stageⅠ andⅡ MM（F=10.046,t= 5.836 and 4.126,P〈0.05）.Both groups had a significant reduction in serum Cys-C level after chemotherapy,and the BDT chemotherapy group had a significantly greater reduction than the VADT chemotherapy group（t=6.242,P〈0.05）. Conclusion Serum Cys-C is a sensitive index for evaluating renal function in patients with MM.Bortezomib-based BDT chemotherapy regimen can significantly reduce serum Cys-C level and improve renal function in patients with MM,and therefore,it can be used as the preferred chemotherapy regimen for patients with MM complicated by renal insufficiency.

关 键 词：多发性骨髓瘤 半胱氨酸蛋白酶抑制物C 肾功能不全 硼替佐米 

分 类 号：R733.3[医药卫生—肿瘤]