硼替佐米+地塞米松联合血液透析治疗多发性骨髓瘤肾病的临床研究
|
摘要
目的:研究硼替佐米+地塞米松(VD方案)联合血液透析(HD)治疗多发性骨髓瘤肾病的临床效果,旨在为更好地治疗多发性骨髓瘤肾病患者提供有效的理论依据。方法:回顾性分析2016年1月至2018年1月我院收治的40例多发性骨髓瘤肾病患者的临床资料,按不同治疗方法将其分成对照组和研究组(每组20例)。对照组给予VD方案治疗,研究组在对照组的基础上联合血液透析(HD)治疗。观察并比较两组患者临床疗效、血清肌酐、血钙、血尿酸、血清免疫球蛋白、轻链蛋白定量水平以及不良反应的具体情况。结果:研究组患者治疗后临床总有效率显著高于对照组(95.00%vs 70.00%)(P<0.05);治疗后,研究组与对照组血清肌酐、血钙、血尿酸等指标水平均较治疗前明显降低,且研究组各指标降低程度大于对照组(P<0.05);治疗后,两组血清免疫球蛋白水平与治疗前比较明显下降(P<0.05),研究组轻链蛋白定量水平降低程度大于对照组(P<0.05);对照组不良反应发生率高于研究组(30.00%vs 5.00%)(P<0.05)。结论:VD方案联合HD对多发性骨髓瘤肾病患者具有良好的临床疗效,能明显改善多发性骨髓瘤肾病患者临床症状以及相关指标水平,且安全性高。
Objective: To study the clinical effect of VD regimen(bortezomib dexamethasone) combined with hemodialysis(HD) in the treatment of multiple myeloma nephropathy in order to provide effective theoretical basis for better treatment of multiple myeloma nephropathy. Methods: 40 patients with multiple myeloma nephropathy treated in our hospital from January 2016 to January 2018 were retrospectively analyzed and divided into two groups according to different treatment, the control group and study group(with 20 cases in each group). Methods: The control group was treated with VD regimen, and the study group was treated with(HD) combined with hemodialysis on the basis of the control group. The clinical therapy effect, serum creatinine, serum calcium, serum uric acid, serum immunoglobulin, light chain protein levels and adverse reactions in two groups were compared. Results: The total effective rate after treatment in the study group was significantly higher than that in the control group(95.0% vs 70.00%)(P<0.05). After treatment, the levels of serum creatinine, serum calcium and uric acid in the study group and the control group were significantly lower than those before the treatment, and the degree of decrease in each index in the study group was greater than that in the control group(P<0.05).After treatment, the level of serum immunoglobulin in the two groups was significantly lower than that before treatment(P<0.05), and the quantitative level of light chain protein in the study group was significantly lower than that before treatment. The incidence of adverse reactions in the control group was higher than that in the study group(30.00% vs 5.00%)(P<0.05). Conclusion: VD regimen combined with HD has a good clinical effect on patients with multiple myeloma nephropathy. It can obviously improve the clinical symptoms and related indexes of the patients with multiple myeloma nephropathy. And the safety is high, so it is worth popularizing and applying further.
Objective: To study the clinical effect of VD regimen(bortezomib dexamethasone) combined with hemodialysis(HD) in the treatment of multiple myeloma nephropathy in order to provide effective theoretical basis for better treatment of multiple myeloma nephropathy. Methods: 40 patients with multiple myeloma nephropathy treated in our hospital from January 2016 to January 2018 were retrospectively analyzed and divided into two groups according to different treatment, the control group and study group(with 20 cases in each group). Methods: The control group was treated with VD regimen, and the study group was treated with(HD) combined with hemodialysis on the basis of the control group. The clinical therapy effect, serum creatinine, serum calcium, serum uric acid, serum immunoglobulin, light chain protein levels and adverse reactions in two groups were compared. Results: The total effective rate after treatment in the study group was significantly higher than that in the control group(95.0% vs 70.00%)(P<0.05). After treatment, the levels of serum creatinine, serum calcium and uric acid in the study group and the control group were significantly lower than those before the treatment, and the degree of decrease in each index in the study group was greater than that in the control group(P<0.05).After treatment, the level of serum immunoglobulin in the two groups was significantly lower than that before treatment(P<0.05), and the quantitative level of light chain protein in the study group was significantly lower than that before treatment. The incidence of adverse reactions in the control group was higher than that in the study group(30.00% vs 5.00%)(P<0.05). Conclusion: VD regimen combined with HD has a good clinical effect on patients with multiple myeloma nephropathy. It can obviously improve the clinical symptoms and related indexes of the patients with multiple myeloma nephropathy. And the safety is high, so it is worth popularizing and applying further.
引文
[1]梁丹丹,黄湘华,任贵生,等.多发性骨髓瘤伴肾脏病变患者的临床病理特征和预后[J].肾脏病与透析肾移植杂志, 2016, 25(5):401-408.
[2]熊瑞芳,封素娟,李寒,等.多发性骨髓瘤肾病的血液净化治疗进展[J].中国血液净化, 2016, 15(12):694-696.
[3]袁瑞丽,刘妮,张凯歌,等.血清轻链κ/λ比值在诊断多发性骨髓瘤和原发性肾病中的临床价值[J].中国医师杂志, 2016, 18(4):539-543.
[4]刘瑜,刘磊,梁勇,等.血液净化辅治多发性骨髓瘤肾病的疗效及其对血肌酐、血尿酸的影响[J].疑难病杂志, 2016, 15(11):1147-1150.
[5]张鹏宇,陈银霞,曹星梅,等.硼替佐米为主的化疗方案治疗初治多发性骨髓瘤疗效观察以及对IL-6和铁蛋白的影响[J].陕西医学杂志, 2016,45(11):1511-1514.
[6]张孝平,夏祖耀,陈宝安,等.骨髓瘤肾病的治疗研究进展[J].中国实验血液学杂志, 2017, 25(2):613-616.
[7]中国医师协会血液科医师分会,中华医学会血液学分会,中国医师协会多发性骨髓瘤专业委员会.中国多发性骨髓瘤诊治指南(2017年修订)[J].中华内科杂志, 2017, 56(11):866.
[8]李富浩,贺红光,唐盛,等.合并肾损害的多发性骨髓瘤患者临床特点及预后[J].广西医学, 2017, 39(11):1623-1626.
[9]张莉,张萍,陈江华.多发性骨髓瘤血液透析患者的临床特点及预后分析[J].中华医学杂志, 2017, 97(8):592.
[10]曹方方,袁媛,王中军,等.毛细管电泳技术在多发性骨髓瘤诊断及MRD监测中的价值[J].现代肿瘤医学, 2017, 25(08):135-137.
[11]王颖,王蕾蕾,马丽,等.血清胱抑素C在多发性骨髓瘤肾功能损害早期诊断及治疗中的临床意义[J].中国医药, 2017, 12(3):382-386.
[12]史小艳,时秋英,徐甜甜,等.中青年血液透析与腹膜透析患者生命质量的多中心调查[J].广东医学, 2016, 37(4):605-607.
[13]顾姗姗,孙琪,杨威.皮下注射硼替佐米治疗多发性骨髓瘤研究进展[J].现代肿瘤医学, 2016, 24(3):505-508.
[14]张宇丽,尹桂茹,毕静,等.地塞米松不同给药方式治疗分泌性中耳炎的临床观察[J].中国药房, 2016, 27(24):3345-3347.
[15]王欢,赵真,张滔,等.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[J].海南医学院学报,2017, 3(1):8.
[2]熊瑞芳,封素娟,李寒,等.多发性骨髓瘤肾病的血液净化治疗进展[J].中国血液净化, 2016, 15(12):694-696.
[3]袁瑞丽,刘妮,张凯歌,等.血清轻链κ/λ比值在诊断多发性骨髓瘤和原发性肾病中的临床价值[J].中国医师杂志, 2016, 18(4):539-543.
[4]刘瑜,刘磊,梁勇,等.血液净化辅治多发性骨髓瘤肾病的疗效及其对血肌酐、血尿酸的影响[J].疑难病杂志, 2016, 15(11):1147-1150.
[5]张鹏宇,陈银霞,曹星梅,等.硼替佐米为主的化疗方案治疗初治多发性骨髓瘤疗效观察以及对IL-6和铁蛋白的影响[J].陕西医学杂志, 2016,45(11):1511-1514.
[6]张孝平,夏祖耀,陈宝安,等.骨髓瘤肾病的治疗研究进展[J].中国实验血液学杂志, 2017, 25(2):613-616.
[7]中国医师协会血液科医师分会,中华医学会血液学分会,中国医师协会多发性骨髓瘤专业委员会.中国多发性骨髓瘤诊治指南(2017年修订)[J].中华内科杂志, 2017, 56(11):866.
[8]李富浩,贺红光,唐盛,等.合并肾损害的多发性骨髓瘤患者临床特点及预后[J].广西医学, 2017, 39(11):1623-1626.
[9]张莉,张萍,陈江华.多发性骨髓瘤血液透析患者的临床特点及预后分析[J].中华医学杂志, 2017, 97(8):592.
[10]曹方方,袁媛,王中军,等.毛细管电泳技术在多发性骨髓瘤诊断及MRD监测中的价值[J].现代肿瘤医学, 2017, 25(08):135-137.
[11]王颖,王蕾蕾,马丽,等.血清胱抑素C在多发性骨髓瘤肾功能损害早期诊断及治疗中的临床意义[J].中国医药, 2017, 12(3):382-386.
[12]史小艳,时秋英,徐甜甜,等.中青年血液透析与腹膜透析患者生命质量的多中心调查[J].广东医学, 2016, 37(4):605-607.
[13]顾姗姗,孙琪,杨威.皮下注射硼替佐米治疗多发性骨髓瘤研究进展[J].现代肿瘤医学, 2016, 24(3):505-508.
[14]张宇丽,尹桂茹,毕静,等.地塞米松不同给药方式治疗分泌性中耳炎的临床观察[J].中国药房, 2016, 27(24):3345-3347.
[15]王欢,赵真,张滔,等.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[J].海南医学院学报,2017, 3(1):8.