雷利度胺联合地塞米松治疗多发性骨髓瘤的临床疗效和安全性分析  

Analysis on Clinical Efficacy and Safety of Lenalidomide Combined with Dexamethasone in the Treatment of Multiple Myeloma Patients

作　　者：杨雷[1] 白培清 宫敬智 孙小燕 金建刚 张维莲[1] 郜小岳 秦玉柱 YANG Lei;BAI Peiqing;GONG Jingzhi;SUN Xiaoyan;JIN Jicmgcmg;ZHANG Weilian;GAO Xiaoyue;QIN Yuzhu(Department of Hematopathology,81st Group Army Hospital of Chinese People's Liberation Army,Zhangjiakou Hebei 075000,China)

机构地区：[1]中国人民解放军陆军81集团军医院血液内科,河北张家口075000 [2]张家口市第一医院内科

出　　处：《华南国防医学杂志》2019年第10期677-680,共4页Military Medical Journal of South China

基　　金：河北省卫生厅科研基金项目(20181552);张家口市科学技术研究与发展计划项目(1712001D)

摘　　要：目的探讨雷利度胺联合地塞米松治疗多发性骨髓瘤患者的临床疗效和安全性。方法以作者医院的88例多发性骨髓瘤患者作为研究对象,根据治疗方案的不同分为对照组和观察组,各44例。对照组施行长春新碱+表柔比星+地塞米松化疗方案,观察组在对照组治疗基础上联合雷利度胺进行治疗,均进行为期4个疗程的治疗。比较两组患者治疗效果、不良反应、治疗前后免疫抑制因子、免疫细胞水平变化。结果观察组的临床总有效率为88.63%,明显高于对照组的临床总有效率59.09%(χ^2=9.948,P=0.002)。治疗前两组患者白细胞介素6(interleukin 6,IL-6),IL-17、转化生长因子β(transforming growth factor beta,TGF-β)比较差异无统计学意义(P>0.05)。治疗后对照组患者IL-6、IL-17水平明显高于观察组(t值依次为15.363、17.326,P均<0.01),TGF-β水平明显低于观察组(t=5.309,P<0.01)。治疗前,两组患者CD3^+、CD4^+、CD8^+、CD4^+/CD8^+比较均无统计学差异(P>0.05)。治疗后,对照组患者CD3^+、CD4^+、CD4^+/CD8^+明显低于观察组(t值依次为5.821、8.399、3.154,P均<0.01),CD8^+明显高于观察组(t=6.956,P<0.01)。两组患者不良反应发生率比较无统计学差异(P>0.05)。结论采取长春新碱+表柔比星+地塞米松联合雷利度胺治疗多发性骨髓瘤疗效更为显著,不良反应小,安全可靠。Objective To analyze the clinical efficacy and safety of lenalidomide combined with dexamethasone in the treatment of multiple myeloma patients.Methods Eighty-eight patients with multiple myeloma in authors′hospital were included and divided into control group and observation group according to different treatment plans,each group with 44 cases.The control group was given a chemotherapy regimen of vincristine+epirubicin+dexamethasone,and the observation group was supplemented with lenalidomide on the basis of the treatment of the control group.All patients were treated for 4 courses.The therapeutic effects,adverse reactions,and the changes in immunosuppressive factors and immune cell levels before and after treatment were compared between two groups.Results The total clinical effective rate of the observation group was significantly higher than that of the control group(88.63%vs.59.09%,χ^2=9.948,P=0.002).There were no significant differences in interleukin 6(IL-6),IL-17 and transforming growth factor beta(TGF-β)between two groups before the treatment.After the treatment,the levels of IL-6 and IL-17 in control group were significantly higher than those in observation group(t=15.363,17.326,all P<0.001),and the TGF-βlevel in control group was significantly lower than that in observation group(t=5.309,P<0.01).Before treatment,there were no significant differences in CD3^+,CD4^+,CD8^+,CD4^+/CD8^+levels between the two groups(P>0.05).After treatment,the levels of CD3^+,CD4^+,CD4^+/CD8^+in control group were significantly lower than those in observation group(t=5.821,8.399,3.154,all P<0.01),and the level of CD8^+in control group was significantly higher than that in observation group(t=6.956,P<0.01).There was no significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion For the treatment of multiple myeloma,the effect of vincristine+epirubicin+dexamethasone combined with lenalidomide is more significant,safe and reliable,and the adverse reactions are small.

关 键 词：雷利度胺 地塞米松 多发性骨髓瘤 临床疗效 安全性 

分 类 号：R733.3[医药卫生—肿瘤]