双磷酸盐联合化疗对多发性骨髓瘤患者骨密度的影响

本研究探讨双磷酸盐联合化疗对多发性骨髓瘤(MM)患者骨密度(BMD)的影响及检测BMD在双磷酸盐治疗MM骨病中的临床应用价值。53例MM患者(33例初治、10例复发/难治、10例平台期)分为2组,氯膦酸盐联合化疗组33例,单纯化疗组20例,两组患者化疗方案完全相同。分别在治疗前和治疗12个月后采用HologicQDR22000型双能X线骨密度仪测量全身、腰椎L1-L4椎体及左股骨近端的BMD值。结果表明,由于样本量较小,且为随机抽取,治疗前2组BMD略有差异,氯膦酸盐联合化疗组全身和腰椎的BMD值略低于单纯化疗组,左股骨颈BMD值2组间无统计学差异。治疗12个月后2组间BMD比较无统计学差异。但氯膦酸盐联合化疗组全身、腰椎及左股骨近端的BMD较治疗前均有明显上升(P<0.01);而单纯化疗组全身及腰椎的BMD与治疗前相比反而有所下降(P<0.01),但左股骨近端BMD值较治疗前有所提高(P=0.01)。结论:双磷酸盐联合化疗对MM患者BMD有良好的作用,检测BMD简便易行,是监测双膦酸盐治疗MM骨病的敏感指标,有临床实用价值。

Influence of Bisphosphonate Combined with Chemotherapy on Bone Mineral Density of Patients with Multiple Myeloma

The purpose of this shtudy was to investigate the effect of bisphosphonate combined with chemotherapy on bone mineral density（BMD） of patients with multiple myeloma（MM） and analyse its value of BMD detection in clinic of these patients.53 MM cases were enrolled in this study,including 33 newly diagnosed,10 refractory/relapsed and 10 stable cases.They were divided randomly into two groups,33 MM cases were treated with bisphosphonates combined with chemotheropy and 20 MM cases were treated with chemotherapy alone.The chemotherapy schedules for all patients were same.BMD was tested using the dual energy X-ray absorptiometry at 2 time points,i.e.pretreatment（basal level） and 12 months after treatment with chemotherapy and bisphosphonates.Comparisons was performed with t tests using SPSS 11.0 software.The results indicated that there was minor difference between 2 groups for BMD scores of whole body and lumbar vertebra（L1-L4）,but no difference for scores of the near-end of left femur.After treatment for 12 months,all BMD scores（whole body,lumbar vertebra and the near-end of left femur） increased significantly in the bisphosphonate combined with chemotherapy group（P 0.05）.In contrast,only minor changes were seen in chemotherapy alone group.It is concluded that the bisphosphonate combined with chemotherapy has displayed promotive effect on BMD of MM patients,the detection of BMD is sensitive and special method for monitoring therapentic effect of bisphosphonate in MM patients,thus has useful value in clinic of these patients.