中西医治疗多发性骨髓瘤周围神经病变进展  

Progress in the treatment of multiple myeloma-associated peripheral neuropathy with Chinese and Western medicine

作　　者：王博[1] 陈媛[1] 王燕[1] WANG Bo;CHEN Yuan;WANG Yan(Hematological Disease Diagnosis and Treatment Center,Taian Central Hospital Affiliated to Qingdao University Taian,Shandong 271000,China)

机构地区：[1]青岛大学附属泰安市中心医院血液病诊疗中心,山东泰安271000

出　　处：《社区医学杂志》2025年第2期67-72,共6页Journal Of Community Medicine

基　　金：山东医药卫生科技发展计划(202203040637);山东省中医药科技项目(2021M064);山东省博士后科学基金(SDCX-ZG-202303060)。

摘　　要：多发性骨髓瘤周围神经病变(MMPN)是多发性骨髓瘤常见的并发症之一,可造成患者感觉神经、运动神经、自主神经受损及功能失调,严重影响患者的生活质量。目前MMPN的发生机制尚不明确,缺乏有效的特异性药物,治疗方式有限,主要以控制原发病、预防及对症治疗为主,严重周围神经病变所致的化疗药物减量或停药,会导致原发病治疗延缓甚至终止,极大影响了患者的疾病治疗。本研究拟围绕MMPN的中西医治疗主题,介绍中医和西医角度MMPN的病因和治疗方式。利用中国知网和PubMed中英文数据库,以“多发性骨髓瘤周围神经病变”“机制和治疗”“硼替佐米”和“中医治疗”为关键词,检索2019-06-01-2024-06-30相关文献。纳入标准:(1)多发性骨髓瘤周围神经病变机制;(2)化疗药物诱导的周围神经病变的预防及治疗;(3)多发性骨髓瘤周围神经病变的中医观点及治疗方式。排除标准:(1)年份较远的综述类文献;(2)文章质量较差、语序较乱的文献。按照以上纳入及排除标准,最终纳入47篇文献。结果显示,周围神经病变仍然是导致多发性骨髓瘤化疗药物减量或停药的重要并发症,严重影响患者的生存质量。其发病机制尚不明确,西医认为与细胞因子介导的损伤、药物在背根神经节的积累、信号通路的异常、基因单核苷酸多态性有关,治疗以神经营养物质、抗氧化剂、抗抑郁药为主,常见的药物包括甲钴胺、维生素B12、加巴喷丁、普瑞巴林、杜洛西汀等。中医认为MMPN与瘀血痰浊阻滞有着密切关系,以活血化瘀、温经通络为治疗原则,方剂、外洗、熏洗、针灸等方式在治疗MMPN中获得了确切的治疗效果。提示,多发性骨髓瘤神经病变仍没有明确的发病机制,未来中西医结合治疗各取优势,互为补充,将有助于提高MMPN的诊治水平,减轻患者症状,改善生活质量。Multiple myeloma peripheral neuropathy(MMPN),as one of the common complications in multiple myeloma,can lead to damage and dysfunction of sensory nerves,motor nerves,and autonomic nerves,thus severely affecting pa-tients quality of life.Currently,the pathogenesis of MMPN remains unclear,and there is a lack of effective specific drugs.Moreover,the treatment options are limited,mainly focusing on controlling the primary disease,prevention,and symptomatic treatment.The reduction or discontinuation of chemotherapy drugs due to severe peripheral neuropathy will result in the delay or even termination of the treatment for the primary disease,which has a great impact on patients treat-ment.This study aims to concentrate on the etiology and treatment of MMPN from the perspectives of traditional Chinese medicine(TCM)and Western medicine.The CNKI and PubMed databases were utilized to search for literatures from June 1,2019,to June 30,2024,with the keywords"multiple myeloma peripheral neuropathy","mechanism and treat-ment","bortezomib",and"TCM treatment".Inclusion criteria:(1)The mechanism of multiple myeloma peripheral neu-ropathy;(2)The prevention and treatment of chemotherapy-induced peripheral neuropathy;(3)The views and treatment methods of TCM regarding multiple myeloma peripheral neuropathy.Exclusion criteria:(1)Review literatures that were relatively old;(2)Literatures with poor article quality and disordered word order.According to the above-mentioned in-clusion and exclusion criteria,47 literatures were finally included.Peripheral neuropathy still remains an important com-plication that causes the reduction or discontinuation of chemotherapy drugs in multiple myeloma patients,which seriously affects their quality of life.Its pathogenesis is still not clear.However,Western medicine holds that it is related to cyto-kine-mediated injury,drug accumulation in the dorsal root ganglion,abnormal signaling pathways,and gene single-nucle-otide polymorphisms.The treatment is mainly based on neurotrophic substances,antioxidan

关 键 词：多发性骨髓瘤 周围神经病变 中医药 综述文献 

分 类 号：R733.3[医药卫生—肿瘤]