内科

目的探讨VAD方案联合硼替佐米治疗多发性骨髓瘤（MM）患者的临床疗效及对患者血清血管细胞黏附分子(sVCAM-1)、可溶性细胞间黏附分子-1(sICAM-1)水平的影响。方法选取2017年1月至2019年1月在我院就诊的MM患者66例为观察对象，采用随机数字法分为观察组与对照组，每组33例。对照组患者采用VAD方案化疗，观察组患者在对照组治疗的基础上加用硼替佐米治疗，治疗21 d为1个周期，两组患者均治疗4周期。比较两组患者的治疗总有效率；检测比较两组患者治疗前后的血清sVCAM-1、sICAM-1水平；比较两组患者的不良反应发生率及1年生存率。结果治疗4个周期，观察组患者的治疗总有效率（72.73%）明显高于对照组（48.48%），差异有统计学意义（P＜0.05）。治疗前，两组患者的sVCAM-1、sICAM-1水平比较，差异无统计学意义（P＞0.05）；治疗4个周期后，两组患者sVCAM-1、sICAM-1水平均显著降低，观察组患者的水平显著低于对照组，差异有统计学意义（P＜0.05）。治疗期间，两组患者的骨髓抑制、消化道反应及血栓形成等不良反应发生率比较，差异均无统计学意义（P＞0.05）。观察组患者的1年生存率（93.94%）显著高于对照组（75.76%），差异有统计学意义（P＜0.05）。结论VAD方案联合硼替佐米治疗多发性骨髓瘤患者，可有效提高临床治疗效果，显著降低血清sVCAM-1、sICAM-1水平，明显提高患者的1年生存率。

ObjectiveTo explore the clinical efficacy of VAD regimen combined with bortezomib in the treatment of multiple myeloma (MM) patients and its effects on the levels of serum soluble vascular cell adhesion molecule-1 (sVCAM-1) and serum soluble intercellular adhesion molecule-1 (sICAM-1). MethodsA total of 66 patients with MM who were treated in our hospital were enrolled as the observed objects from January 2017 to January 2019. They were divided into observation group and control group by the random number method, with 33 cases in each group. The control group was treated with the regimen of VAD chemotherapy, based on which the observation group was additionally treated with bortezomib, a treatment cycle lasted 21 days and four treatment cycles were conducted for both groups. The total effective rate was compared between the two groups. The serum sVCAM-1 and sICAM-1 levels of the two groups before and after treatment were tested and compared. The incidence of adverse reactions and the 1-year survival rate of the two groups were compared. ResultsAfter 4 cycles of treatment, the total effective rate of the observation group (72.73%) was higher than that of the control group (48.48%), with a statistically significant difference (P＜0.05). Before treatment, there were no statistically significant differences in the levels of sVCAM-1 and sICAM-1 between the two groups (P＞0.05). After 4 cycles of treatment, the levels of sVCAM-1 and sICAM-1 in the two groups significantly decreased, and the observation group yielded lower levels in comparison with the control group, with statistically significant differences (P＜0.05). During the treatment period, there was no statistically significant difference in the incidence of adverse reactions between the two groups, such as bone marrow suppression, gastrointestinal reactions and thrombosis (P＞0.05). The 1-year survival rate of the observation group (93.94%) was significantly higher than that of the control group (75.76%), with a statistically significant difference (P＜0.05). ConclusionVAD regimen combined with bortezomib in the treatment of multiple myeloma patients can effectively improve the clinical therapeutic effect, significantly decrease the serum sVCAM-1 and sICAM-1 levels, and prominently improve the 1-year survival rate of patients.