CAJ | 학술논문

目的：观察和比较VMDT方案和VAD方案在治疗多发性骨髓瘤的临床疗效和不良反应。方法选择2007年8月～2014年8月我院收治的多发性骨髓瘤患者64例，随机分为两组，VMDT组32例，VAD组32例。分别采用VMDT方案和VAD方案化疗4个疗程，比较两组的临床疗效和不良反应。结果 VMDT组的临床有效率为81.25％，VAD组的临床有效率为56.25％，VMDT组的临床疗效显著优于VAD组，差异具有统计学意义（P＜0.05）。临床的主要指标方面，VMDT组的M蛋白下降50％以上为62.50％，骨髓瘤细胞下降80％以上占62.50％，血红蛋白上升20g/L占56.25％，VAD组M蛋白下降50％以上为50.00％，骨髓瘤细胞下降80％以上占53.13％，血红蛋白上升20g/L占50％，VMDT组显著优于VAD组，差异具有统计学意义（P＜0.05）。在不良反应反面，VMDT组在便秘，疲乏，乏力和肝肾功能损害方面显著优于VAD组（P＜0.05），在口干，肢体麻木，消化道症状方面，两组比较差异无统计学意义（P＞0.05）。结论相对于传统的VAD方案，VMDT方案更好，使用糖皮质激素量较少，临床有效率更高，副作用较低，且较适合基层医院应用，值得临床推广应用。
목적：관찰화비교VMDT방안화VAD방안재치료다발성골수류적림상료효화불량반응。방법선택2007년8월～2014년8월아원수치적다발성골수류환자64례，수궤분위량조，VMDT조32례，VAD조32례。분별채용VMDT방안화VAD방안화료4개료정，비교량조적림상료효화불량반응。결과 VMDT조적림상유효솔위81.25％，VAD조적림상유효솔위56.25％，VMDT조적림상료효현저우우VAD조，차이구유통계학의의（P＜0.05）。림상적주요지표방면，VMDT조적M단백하강50％이상위62.50％，골수류세포하강80％이상점62.50％，혈홍단백상승20g/L점56.25％，VAD조M단백하강50％이상위50.00％，골수류세포하강80％이상점53.13％，혈홍단백상승20g/L점50％，VMDT조현저우우VAD조，차이구유통계학의의（P＜0.05）。재불량반응반면，VMDT조재편비，피핍，핍력화간신공능손해방면현저우우VAD조（P＜0.05），재구간，지체마목，소화도증상방면，량조비교차이무통계학의의（P＞0.05）。결론상대우전통적VAD방안，VMDT방안경호，사용당피질격소량교소，림상유효솔경고，부작용교저，차교괄합기층의원응용，치득림상추엄응용。
Objective To observe and to compare the clinical effect and adverse reaction of VMDT scheme and VAD scheme in the treatment of multiple myeloma. Methods 64 patients with multiple myeloma, who were received and cured in our hospital from August 2007 to August 2014, were selected and randomly divided into VMDT group and VAD group, with 32 cases in each group. To respectively adopt VMDT scheme and VAD scheme with 4 courses of chemotherapy, to compare the clinical effect and adverse reaction between the two groups. Results The clinical effective rate in VMDT group(81.25 % ) was obviously better than which in VAD group(56.25 % ), the differences was statically significant(P < 0.05). Of the primary clinical index aspect, M protein in VMDT group(62.50%) and in VAD group(50.00%) had declined more than 50%, myeloma cells in VMDT group(62.50%) and in VAD group(53.13%) had declined more than 80%, hemoglobin in VMDT group(56.25%) and in VAD group(50.00%) had risen 20g/L, which in VMDT group was significantly better than which in VAD group, the differences was statically significant (P<0.05). The adverse reaction of constipation, fatigue, hypodynamia, function lesion of liver and kidney in VMDT group was siginificantly better than which in VAD group(P<0.05), the adverse reaction of dry mouth, limb numbness, digestive tract symptom in VMDT group was no statistical significance (P > 0.05). Conclusion VMDT scheme is much better than conventional VAD scheme with lesser glucocorticoid, has higher clinical effective rate and lower side effect, is applied compatibly in primary hospital, and is worthy of clinical popularization and application.