CAJ | 학술논문

目的探讨不同的治疗方案[BD(硼替佐米+地塞米松)、TID(沙利度胺+地塞米松)]对多发性骨髓瘤(MM)骨病的影响.方法 2006年11月至2008年9月,分别应用硼替佐米和沙利度胺联合地塞米松治疗的初治及难治复发MM患者共40例.在2种不同化疗方案前后,对患者进行骨痛评分、X线检查,同时采用ELISA法检测血清成骨细胞抑制因子DKK-1、可溶性细胞核因子κB受体活化因子配体(sRANKL)和抗酒石酸酸性磷酸酶(TRACP)-5b等骨代谢因子的水平.结果 TD组治疗前后中位血清TRACP-5b水平分别为5.94 U/L和4.84 U/L(P＜0.05).BD组有效患者治疗前后中位血清DKK-1浓度分别为35.11 μg/L和32.03 μg/L(P＜0.05);血清sRANKL浓度分别为1.05 pmol/L和0.67 pmol/L(P＜0.05);血清TRACP-5b浓度分别为5.57 U/L和4.90U/L(P＜0.05).结论硼替佐米治疗有效的患者通过下调血清DKK-1、sRANKL和TRACP-5b水平从而可能显著增加骨形成活动,减少骨吸收活动;沙利度胺治疗的患者骨吸收活动显著减少.
목적 탐토불동적치료방안[BD(붕체좌미+지새미송)、TID(사리도알+지새미송)]대다발성골수류(MM)골병적영향.방법 2006년11월지2008년9월,분별응용붕체좌미화사리도알연합지새미송치료적초치급난치복발MM환자공40례.재2충불동화료방안전후,대환자진행골통평분、X선검사,동시채용ELISA법검측혈청성골세포억제인자DKK-1、가용성세포핵인자κB수체활화인자배체(sRANKL)화항주석산산성린산매(TRACP)-5b등골대사인자적수평.결과 TD조치료전후중위혈청TRACP-5b수평분별위5.94 U/L화4.84 U/L(P＜0.05).BD조유효환자치료전후중위혈청DKK-1농도분별위35.11 μg/L화32.03 μg/L(P＜0.05);혈청sRANKL농도분별위1.05 pmol/L화0.67 pmol/L(P＜0.05);혈청TRACP-5b농도분별위5.57 U/L화4.90U/L(P＜0.05).결론 붕체좌미치료유효적환자통과하조혈청DKK-1、sRANKL화TRACP-5b수평종이가능현저증가골형성활동,감소골흡수활동;사리도알치료적환자골흡수활동현저감소.
Objective To explore the difference of effects of two regimens (bortezomib and dexamethasone, BD; and thalidomide and dexamethasone, TD) on bone disease in multiple myeloma(MM).Methods Forty patients with newly diagnosed and refractory or relapsed MM were treated with BD or TD regimens from Dec 2006 to Sep 2008. Bone pain score and X-ray examination were carried out before and after therapy. Serum levels of DKK-1, sRANKL, OPG and TRACP-5b were measured by ELISA before and 3 months after therapy. Results Serum TRACP-5b concentration was significantly decreased in patients received TD regimen (5.94 U/L before therapy vs 4.84 U/L 3 months after therapy ,P ＜ 0.05), and so did for serum DKK-1 concentration in patients responded to BD regimen (35.11 μg/L before vs 32.03 μg/L 3 months after therapy,P ＜0.05) ;for serum concentration of sRANKL in patients responded to BD regimen (1.05 pmol/L before vs 0.67 pmol/L 3 months after therapy, P ＜ 0. 05); and for serum concentration of TRACP-5b in responders to BD regimen (5.57 U/L before therapy vs 4.90 U/L 3 months after therapy ,P ＜0.05). Conclusion Bortezomib lowers levels of serum DKK-1 and RANKL in responders, thus leads to normalization of abnormal bone remodeling through the increase of bone formation and reduction of bone resorption. Thalidomide decreases bone resorption regardless of treatmant response.