海南医科大学学报

目的:硼替佐米联合地塞米松治疗老年多发性骨髓瘤的疗效及对免疫抑制因子、免疫细胞水平的影响。方法:选择2013年10月~2015年7月于首都医科大学附属北京友谊医院就医的80例多发性骨髓瘤作为研究对象。随机分为43例观察组和37例对照组,其中观察组采取硼替佐米联合地塞米松的治疗方式,对照组采取长春新碱+表柔比星+地塞米松的治疗方式。3个疗程后,比较两组患者的疗效,同时比较治疗前及治疗后不同时间的免疫抑制因子及免疫细胞水平。结果:治疗3个疗程后,观察组的总有效率显著高于对照组(P<0.01)。治疗前两组患者的IL-6、IL-17、TGF-β、CD3~+CD4⁺、CD3~+CD8⁺、CD3~+CD4⁺/CD3~+CD8⁺比较差异无统计学意义(P>0.05);治疗6周,观察组的IL-6、IL-17水平与本组治疗前相比显著降低(P<0.05,P<0.01);治疗12周,观察组的IL-6、IL-17、TGF-β水平与本组治疗前相比显著降低(P<0.05,P<0.01);治疗后,观察组的IL-6、IL-17水平显著低于同期的对照组(P<0.05,P<0.01)。治疗后12周,观察组的CD3~+CD4⁺、CD3~+CD4⁺/CD3~+CD8⁺均显著高于本组治疗前(P<0.05),且显著高于同期的对照组(P<0.05);观察组的CD3~+CD8⁺显著低于本组治疗前(P<0.01),且显著低于同期的对照组(P<0.05)。结论:相比较于长春新碱+表柔比星+地塞米松治疗方式,硼替佐米联合地塞米松治疗老年多发性骨髓瘤的疗效更显著,值得进一步的临床研究。

Objective:To investigate the effects of bortezomib and dexamethasone combination on treating senile multiple myeloma and influence on immune suppressed factors and immune cell levels.Methods:A total of 80 cases of patients with multiple myeloma treated in our hospital from October 2013 to July 2015 were selected as investigate subjects.They were randomly divided into observation group with 43 cases and control group with 37 cases.For observation group,treatment of bortezomib and dexamethasone combination was provided.For control group,vincristine+epirubicin+dexamethasone treatment was provided.After three courses,effects on two groups of patients were compared,and immune suppressed factors and immune cell levels before and after treatment in different periods were compared.Results:After three courses of treatment,the total effective rate in observation group was significantly higher than control group(χ²=14.687,P<0.01).Before treatment,IL-6,IL-17,TGF-β,CD3~+CD4⁺,CD3~+CD8⁺ and CD3~+CD4⁺/CD3~+CD8⁺ between the two group of patients were compared and no significant difference showed(P>0.05);After treatment for 6 weeks,IL-6,IL-17 levels in observation group were significantly decreased compared with the same group before treatment(P<0.05,P<0.01);After treatment for 12 weeks,IL-6,IL-17 and TGF-βlevels in observation group were significantly decreased compared with the same group before treatment(P<0.05,P<0.01);After treatment,IL-6,IL-17 levels in observation group were significantly lower than control group at the same phase(P<0.05,P<0.01).After treatment for 12 weeks,CD3~+CD4⁺,CD3~+CD4⁺/CD3~+CD8⁺ in observation group were significantly higher than the same group before treatment(P<0.05),and significantly higher than control group at the same phase(P<0.05);CD3~+CD8⁺ in observation group was significantly lower than the same group before treatment(P<0.01),and significantly lower than control group at the same phase(P<0.05).Conclusions:Compared with vincristine+epirubicin+dexamethasone treatment,bortezomib and dexamethasone combination on treating senile multiple myeloma had more significant effects,which deserves further clinical researches.