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目的探讨低剂量环磷酰胺联合泼尼松(CP方案)治疗多发性骨髓瘤的临床疗效及其对血清血管内皮生长因子(VEGF)和血小板源性生长因子BB(PDGF-BB)水平的影响。方法 54例难治或复发性多发性骨髓瘤患者给予低剂量环磷酰胺(CTX,50 mg/d)联合泼尼松(Pred,15 mg/d)持续口服,评价疗效。于治疗前和治疗后2、4、6个月分别取患者的血清并应用ELISA法检测血清中VEGF和PDGF-BB的表达。结果治疗总有效率达69%(36/52)。其中有效并重复检测血清标本4次的患者30例(其中完全缓解2例,非常好的部分缓解4例,部分缓解24例),可评估无效患者7例。此30例有效组多发性骨髓瘤患者治疗2、4、6个月后血清VEGF和PDGF-BB水平与治疗前相比均降低,差异有统计学意义(P<0.01);而7例无效组多发性骨髓瘤患者治疗2个月后血清VEGF和PDGF-BB水平与治疗前相比差异无统计学意义。结论低剂量环磷酰胺联合泼尼松治疗多发性骨髓瘤患者有明显疗效,并可降低血清VEGF及PDGF-BB水平。推测其在多发性骨髓瘤中的作用机制可能与抑制新生血管的生成有关。
Objective To investigate the clinical effects of low dose cyclophosphamide combined with prednisone (CP regimen) in the treatment of multiple myeloma and its effect on the levels of serum vascular endothelial growth factor (VEGF) and platelet derived growth factor BB (PDGF-BB). Methods 54 patients with refractory or recurrent multiple myeloma were given oral low dose cyclophosphamide (CTX, 50 mg / d) and prednisone (Pred, 15 mg / d) orally continuously to evaluate the curative effect. The serum of patients was taken before treatment and at 2, 4 and 6 months after treatment, and the expression of VEGF and PDGF-BB in serum was detected by ELISA. Results The total effective rate of treatment was 69% (36/52). Among them, 30 cases were effective and repeated testing 4 times of serum samples (2 cases were completely relieved, 4 cases were very good partial remission and 24 cases partial remission), and 7 cases could be evaluated as invalid. The levels of serum VEGF and PDGF-BB in these 30 patients with multiple myeloma after 2, 4 and 6 months of treatment were significantly lower than those before treatment (P <0.01), while those in 7 ineffective groups The levels of serum VEGF and PDGF-BB in patients with multiple myeloma after 2 months of treatment were not significantly different from those before treatment. Conclusion Low dose cyclophosphamide combined with prednisone has obvious curative effect in patients with multiple myeloma and can reduce serum VEGF and PDGF-BB levels. It is speculated that the mechanism of action in multiple myeloma may be related to the inhibition of neovascularization.