伊沙佐米联合地塞米松沙利度胺治疗难治性多发性骨髓瘤的临床研究  

Effects of Isazomib Combined with Dexamethasone and Thalidomide in the Treatment of Refractory Multiple Myeloma

作　　者：魏冰 李月红[1] 张晓娇 朱太岗[1] WEI Bing;ZHU Taigang;LI Yuehong(General Hospital of Anhui Wanbei Coal and Power Group, u Anhui Suzho 234000, China)

机构地区：[1]安徽皖北煤电集团总医院血液科,安徽宿州234000

出　　处：《河北医学》2022年第2期336-341,共6页Hebei Medicine

基　　金：安徽省卫生厅医药科研计划项目,(编号:12925KJ2017B24)。

摘　　要：目的:探讨伊沙佐米联合地塞米松、沙利度胺对难治性多发性骨髓瘤(MM)患者骨代谢、炎症状态及血清纤维蛋白原降解产物(FDP)、D-二聚体(D-D)、血小板因子4(PF4)水平的影响。方法:选取2019年9月至2021年3月我院难治性多发性骨髓瘤MM患者82例,以简单随机化法分为研究组(n=41)、对照组(n=41)。研究组采取伊沙佐米联合地塞米松、沙利度胺治疗,对照组采取传统VAD(长春新碱+地塞米松+阿霉素),4周为1个疗程,均治疗4个疗程。比较两组疾病缓解率与治疗前、治疗2个疗程、4个疗程后血清骨代谢指标[骨钙素(BGP)、碱性磷酸酶(ALP)、Ⅰ型胶原C末端肽(CTX-Ⅰ)]、炎症因子指标[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、肾功能指标[血尿素氮(BUN)、血肌酐(SCr)]、FDP、D-D、PF4水平,统计不良反应发生率。结果:与对照组比较,研究组疾病缓解率显著提高,有统计学差异(75.61%vs51.22%,χ^(2)=5.256,P<0.05);与对照组相比,研究组治疗2个疗程、4个疗程后血清BGP、ALP水平显著升高,CTX-Ⅰ水平显著降低(P<0.05);与对照组相比,研究组治疗2个疗程、4个疗程后血清CRP、TNF-α、FDP、D-D、血清BUN、SCr水平均显著降低,(P<0.05);治疗期间,两组不良反应发生率差异均无统计学意义(P>0.05)。结论:采用伊沙佐米联合地塞米松、沙利度胺治疗难治性MM患者,能显著提高疾病缓解率,进一步调节血清FDP、D-D、PF4水平,减轻患者炎症状态,改善骨代谢,且具有一定安全性。Objective:To investigate the effects of isazomib combined with dexamethasone and thalidomide on bone metabolism,inflammatory state and the levels of serum fibrinogen degradation product(FDP),D-Dimer(D-D)and platelet factor 4(PF4)in patients with refractory multiple myeloma(mm).Methods:82 patients with refractory MM in our hospital from September 2019 to March 2021 were randomly divided into study group(n=41)and control group(n=41).The study group was treated with isazomib combined with dexamethasone and thalidomide,and the control group was treated with traditional VAD(vincristine+dexamethasone+adriamycin)for 4 weeks.The remission rates of the two groups were compared with the indexes of serum bone metabolism[Osteocalcin(BGP),alkaline phosphatase(ALP),type I collagen C-terminal peptide(CTX-I)]and inflammatory factor[tumor necrosis factor]before treatment,2 courses of treatment and 4 courses of treatment-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)],renal function indexes(blood urea nitrogen(BUN),blood creatinine(SCR)],FDP,D-D and PF4 levels,and the incidence of adverse reactions was counted.Results:Compared with the control group,the disease remission rate of the study group was significantly improved,with statistical difference(75.61%vs51.22%,χ^(2)=5.256,P<0.05);compared with the control group,the study group had 2 courses of treatment and 4 courses of treatment,the serum BGP and ALP levels increased significantly,and the CTX-I level decreased significantly(P<0.05);compared with the control group,the serum CRP,TNF-α,FDP,DD,serum BUN,and SCr levels of the study group were significantly reduced after 2 courses and 4 courses of treatment(P<0.05);during the treatment period,the two groups had adverse reactions,but there was no statistically significant difference in incidence(P>0.05).Conclusion:The treatment of refractory MM patients with isazomib combined with dexamethasone and thalidomide can significantly improve the disease remission rate,further regulate the levels of serum FDP,D-D and PF4,reduce th

关 键 词：多发性骨髓瘤 炎症状态 沙利度胺 伊沙佐米 难治性 

分 类 号：R733.3[医药卫生—肿瘤]