硼替佐米联合双膦酸盐对多发性骨髓瘤骨代谢指标的影响及意义

本研究旨在探讨双膦酸盐联合不同化疗方案对多发性骨髓瘤患者骨代谢指标血清Dickkopf-1（DKK-1）、核因子NF—κB配体受体激活蛋白（RANKL）的影响,证实硼替佐米联合双膦酸盐对溶骨性骨病的治疗作用。43例初治及难治复发患者分为2组,硼替佐米联合唑来膦酸治疗组23例（A组）,传统化疗联合唑来膦酸治疗组（B组）20例。应用酶联免疫吸附试验（ELISA法）检测DKK-1和RANKL浓度。结果表明,A组治疗前、后血清DKK-1中位水平分别为43．2和30．4μg/L（P〈0．05）,而B组治疗前、后血清DKK-1中位水平分别为45．6和40．9μg/L（P〈0．05）。A组与B组相比,治疗前DKK-1浓度差异无统计学意义（P〉0．05）,治疗后A组DKK-1浓度明显低于B组（P〈0．05）。A组治疗前、后血清RANKL中位水平分别为0．83pmmoL／L和0．45pmmol／L,差异有统计学意义（P〈0．05）;而B组治疗前、后血清RANKL中位水平分别为0．79pmmol／L和0．65pmmol／L,差异有统计学意义（P〈0．05）。A组与B组相比,治疗前DKK-1浓度差异无统计学意义（P〉0．05）,治疗后DKK-1浓度明显低于B组（P〈0．05）。结论：硼替佐米联合双膦酸盐明显减低MM患者血清DKK-1、RANKL水平,对MM溶骨性骨病有-定的治疗价值。

Effect of Bortezomib Combined with Bisphosphonates on Bone Metabolism Index in Multiple Myeloma

This study was aimed to investigate the effect of bortezomib combined with bisphosphonates on serum levels of DKK-1 and RANKL in multiple myeloma patients, and to evaluate its role in the therapy of osteolytic lesion. Fourty-three patients with newly diagnosed and relapsed myeloma were divided into 2 groups. Twenty-three patients were treated with bortezomib combined with bisphosphonates （A group） and 20 patients were treated with bisphosphonates combined with traditional chemotherapy （ B group）. Serum levels of DKK-1 and RANKL were measured by ELISA before and after 4 cycles of chemotherapy. The results indicated that serum DKK-1 level significantly decreased in patients of A group （43.2 μg/L before vs 30.4 μg/L after 4 cycles of chemotherapy）, and so did for serum RANKL level in A group （0. 83 pmmol/L before vs 0. 45 pmmol/L after 4 cycles of chemotherapy）. While there was no significant differences in DKK-1 and RANKL serum level before therapy between A and B groups, but there was significant differences in DKK-1 and RANKL levels after 4 cycles of chemotherapy （ P 〈 0. 05 ）. It is concluded that bortezomib combined with bisphosphonates obviously reduce the serum levels of DKK-1 and RANKL, thus has beneficial effect on osteolytic lesion.