初诊多发性骨髓瘤176例临床特点及化疗效果观察

目的：探讨初诊多发性骨髓瘤（MM）的临床特征及治疗反应。方法对176例初诊 MM 患者的临床资料及治疗方法进行回顾性分析。结果骨痛是 MM 患者初诊时最常见的主诉，26.1%（46／176）的患者发生过误诊。治疗的总有效率为65.9%（116／176），硼替佐米方案治疗组治疗总有效率为81.0%（34／42），高于 M2方案治疗组（61.8%，34／55）及 VAD 方案治疗组（60.8%，48／79）（均Ρ＜0.05），硼替佐米方案治疗组疗效在肾功能正常及肾功能不全两亚组之间差异无统计学意义（Ρ＞0.05）。血液学毒性、感染、外周神经毒性为最常见的不良反应。多脏器衰竭为最主要的死亡原因（47.1%，16／34）。结论 MM 临床表现复杂多样，易发生误诊；分子遗传学异常与预后密切相关，蛋白酶体抑制剂硼替佐米的应用可提高疗效，且不受肾功能影响。积极防治感染和肾功能不全是延长患者生存时间的重要手段。

Clinical characteristics and chemotherapy efficacy in patients with newly diagnosed multiple myeloma:observation of 176 cases

Objective To investigate the clinical characteristics and treatment efficacy in newly diagnosed multiple myeloma (MM). Methods The clinical data and treatment methods of 176 patients with newly diagnosed MM were retrospectively analyzed. Results The most common chief complaint in the patients with MM was bone pain. 26.1 % (46/176) patients once experienced misdiagnosis. The overall response rate (ORR) was 65.9 % (116/176), the ORR of bortezomib group (81.0 %, 34/42) was significantly higher than that of M2 regimen group (61.8 %, 34/55) and VAD regimen group (60.8 %, 48/79) (P<0.05). Between normal renal function subgroup and renal insufficiency subgroup in bortezomib group, the efficacy was no significant difference (P>0.05). The most common adverse reactions included hematologic toxicity, infection and peripheral neurotoxicity. Multiple organ failure was the main cause of death (47.1 %, 16/34). Conclusions The clinical manifestations of MM are complex and diverse, which is easy to be misdiagnosed. Molecular genetic abnormalities are closely related to prognosis. Proteasome inhibitor bortezomib can improve the curative effect and not be affected by renal function. To prolong the survival time of the patients needs to prevent and control the infection and renal insufficiency actively.