【摘要】 目的:评价不同剂量地塞米松联合硼替佐米和沙利度胺治疗初发多发性骨髓瘤患者的临床效果及安全性。方法:选取我医院2013年1月-2014年1月期间的96例多发性骨髓瘤患者,将入组患者分为A(高剂量地塞米松+硼替佐米+沙利度胺,32例)、B(低剂量地塞米松+硼替佐米+沙利度胺,32例)、C(安慰剂+硼替佐米+沙利度胺,32例)3组,比较3组患者临床疗效及安全性指标。结果:A组和B组总缓解率均明显高于C组(P<0.05),A与B组之间无统计学差异(P>0.05)。治疗后3组患者KPS评分均明显高于治疗前,RNS评分均明显低于治疗前;A、B两组KPS评分明显高于C组,RNS评分明显低于C组(P<0.05),A、B 2组之间KPS及RNS评分均无统计学差异(P>0.05);治疗后3组患者CD38、CD56、CD138阳性表达率及SRL阳性率均明显低于治疗前,CD19阳性表达率明显高于治疗前;A、B组CD38、CD56、CD138阳性表达率及SRL阳性率均明显低于C组,CD19则明显高于C组,差异均有统计学意义(P<0.05),A、B组之间CD19、CD38、CD56、CD138阳性表达率及SRL阳性率均无统计学差异(P>0.05);B、C组在乏力、皮疹、周围神经病变、贫血、粒细胞缺乏等方面发生率均明显低于A组(P<0.05),B、C组之间无统计学差异(P>0.05)。结论:不同剂量地塞米松联合硼替佐米及沙利度胺治疗多发性骨髓瘤患者的疗效相似,可明显提高缓解率,延长生存期,改善生活质量,但低剂量患者不良反应发生率明显降低,安全性更佳。更多还原

【Abstract】 Objective: To study the clinical efficacy and safety of dexamethasone of different doses combined with bortezomib and thalidomide for treatment of primary multiple myeloma.Methods: Ninety-six patients with multiple myeloma from January 2013 to January 2014 were randomly divided into group A( high-dose dexamethasone +bortezomib + thalidomide,32 cases),group B( low-dose dexamethasone + bortezomib + thalidomide,32 cases) and group C( placebo + bortezomib + thalidomide,32 cases).The clinical efficacy and safety of patients was compared among 3 groups.Results: The overall remission rate( ORR) in group A and B was significantly higher than that in group C( P < 0.05),but the ORR was not significant difference between group A and group B( P > 0.05).After treatment,the KPS and RNS score in 3 groups were significantly higher and lower than those before treatment,respectively; the KPS score in group A and B was significantly higher than that in group C( P < 0.05),the RNS score in group A and B was significantly lower C( P < 0.05).After treatment,the positive expression rates of CD38,CD56 and CD138 as well as small residual lesion( SRL) positive rate in 3 grops were significantly lower than those before treatment,but the positive expression rate of CD19 was significantly higher that before treatment; the positive expression rates of CD38,CD56 and CD138 as well as SRL positive rate in group A and B were significantly lower thant those in group C,while the positive expression rate of CD19 was significantly higher that in group C( P < 0.05),but the positive expression rates of CD19,CD38,CD56 and CD138 as well as SRL positive rate were not significantly different between group A and B( P > 0.05).The incidence of fatigue,rash,peripheral neuropathy,anlmia,granulocyte deficiance and so on in group B and C was significantly lower than that in group A( P < 0.05),but the difference in group B and C was not significant( P > 0.05).Conclusion: The therapeutic efficacy of different doses of dexamethasone combined with bortezomib and thalidomide for patients with multiple myeloma is similar,can obviously enhance remission rate,prolong the survival time,promote life quality,but the incidence of adverse reactions in low dose dexamethason rigemen is significantly reduced,and the safety is better.更多还原