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目的探究沙利度胺联合伊曲康唑治疗多发性骨髓瘤合并肺部感染的临床疗效。方法选取2013年3月至2016年12月间广东省东莞市人民医院收治的50例多发性骨髓瘤合并肺部感染患者,采用随机数字表法分为观察组与对照组,每组25例。对照组患者服用沙利度胺片治疗,观察组患者在对照组基础上联合伊曲康唑治疗。比较两组患者临床疗效;测量两组患者治疗前后血清中M蛋白比例、骨髓浆细胞比例、血红蛋白含量、肿瘤坏死因子α(TNF-α)及生长因子(VEGF)含量;统计两组患者治疗期间不良反应发生情况。结果观察组患者临床总有效率为100.0%,显著优于对照组患者的84.0%,差异有统计学意义(P<0.05)。两组患者治疗前,血清中M蛋白比例、骨髓浆细胞比例及血红蛋白含量比较,无显著性差异;治疗后,观察组患者血清中M蛋白比例及骨髓浆细胞比例显著下降,血红蛋白含量显著升高,且与对照组相比,差异均有统计学意义(均P<0.05)。两组患者治疗前,血清中TNF-α及VEGF含量无显著性差异;治疗后,观察组患者血清中TNF-α及VEGF含量显著下降,且与对照组相比,差异均有统计学意义(均P<0.05)。两组患者治疗期间均未发生严重不良反应。结论沙利度胺联合伊曲康唑治疗多发性骨髓瘤合并肺部感染,临床效果显著,安全性良好,能够显著减少患者血清TNF-α及VEGF含量,值得推广。
Objective To investigate the clinical efficacy of thalidomide and itraconazole in the treatment of multiple myeloma with pulmonary infection. Methods Fifty patients with multiple myeloma with pulmonary infection admitted to Dongguan People’s Hospital of Guangdong Province between March 2013 and December 2016 were randomly divided into observation group and control group with 25 cases in each group. Patients in the control group were treated with thalidomide, while patients in the observation group were treated with itraconazole on the basis of the control group. The clinical efficacy of the two groups were compared. The levels of M protein, the proportion of plasma cells, hemoglobin, tumor necrosis factor-α (TNF-α) and growth factor (VEGF) in two groups were measured before and after treatment. Adverse reactions occurred. Results The total effective rate of observation group was 100.0%, which was significantly better than that of the control group (84.0%), the difference was statistically significant (P <0.05). There was no significant difference in serum M protein, bone marrow plasma cell ratio and hemoglobin before treatment in both groups. After treatment, the proportion of M protein in serum and the proportion of bone marrow plasma cells in the observation group decreased significantly, and the hemoglobin content was significantly increased , Compared with the control group, the difference was statistically significant (P <0.05). Before treatment, there was no significant difference in the levels of TNF-α and VEGF in serum between the two groups. After treatment, the levels of TNF-α and VEGF in the serum of patients in the observation group decreased significantly, and the differences were statistically significant All P <0.05). Two groups of patients during the treatment did not occur serious adverse reactions. Conclusions Thalidomide combined with itraconazole in the treatment of multiple myeloma with pulmonary infection has significant clinical effect and good safety, which can significantly reduce the serum levels of TNF-α and VEGF, which is worth promoting.