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目的观察酞咪哌啶酮联合地塞米松治疗多发性骨髓瘤(MM)的疗效、机制及不良反应。方法反应停起始剂量150 mg/d,每周增加50~100 mg/d,直至200~300 mg/d;地塞米松40 mg/d,第1~4天,第9~12天,第17~20天,28 d为1疗程。用免疫组化染色方法检测治疗前后患者骨髓微血管密度(MVD),用ELISA方法测定患者治疗前后血清血管内皮细胞生长因子(VEGF)的浓度。结果18例MM患者中部分缓解5例,进步9例,无效4例,无完全缓解患者,总有效率77.8%,无不能耐受的不良反应。治疗前MVD(74±29)显著高于治疗后MVD(57±18)(P<0.05),两组均明显高于正常对照组MVD(31±12)(P<0.01)。治疗后血清VEGF水平为(72±20)ng/L,显著低于治疗前(181±26)ng/L(P<0.01),两组与正常对照组(56±16)ng/L比较差异均有统计学意义(P<0.05)。结论MM患者MVD和VEGF明显增高,经酞咪哌啶酮联合地塞米松治疗后两者均明显下降。反应停联合地塞米松治疗多发性骨髓瘤(MM)有效、安全。
Objective To observe the efficacy, mechanism and adverse reactions of thalidomide combined with dexamethasone in the treatment of multiple myeloma (MM). Methods The initial dose of reaction was stopped at 150 mg / d, with a weekly increase of 50-100 mg / d until 200-300 mg / d, dexamethasone 40 mg / day, days 1-4, 9-12, 17 to 20 days, 28 days for a course of treatment. The bone marrow microvessel density (MVD) of the patients before and after treatment was detected by immunohistochemical staining, and the concentration of serum vascular endothelial growth factor (VEGF) in the patients before and after treatment was measured by ELISA. Results Among the 18 MM patients, 5 were partly relieved, 9 were improved and 4 were ineffective. The patients with complete remission had a total effective rate of 77.8% without adverse reactions. Before treatment MVD was significantly higher (74 ± 29) than MVD after treatment (57 ± 18) (P <0.05), both groups were significantly higher than the normal control group MVD (31 ± 12) (P <0.01). The level of serum VEGF was (72 ± 20) ng / L after treatment, which was significantly lower than that before treatment (181 ± 26) ng / L (P <0.01) All were statistically significant (P <0.05). Conclusion The MVD and VEGF were significantly increased in patients with MM, the two were significantly decreased after treatment with thalidomide combined dexamethasone. Response to dexamethasone combined with multiple myeloma (MM) effective and safe.