Biochemical, histomorphometric and densitometric changes in patients with multiple myeloma: Effects of glucocorticoid therapy and disease activity
Biochemical, histomorphometric and densitometric changes in patients with multiple myeloma: Effects of glucocorticoid therapy and disease activity
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DOI：
10.1046/j.1365-2141.1997.1042920.x
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发表时间：
1997-06-01
影响因子：
6.5
通讯作者：
Kwan, YK
中科院分区：
文献类型：
--
作者：
Diamond, T;Levy, S;Kwan, YK
多发性骨髓瘤（MM）的骨改变是否是由于异常浆细胞克隆或大剂量糖皮质激素治疗引起的骨吸收尚不清楚。我们研究了25例MM患者，接受1-12个疗程的联合化疗，分为两组。第1组包括12例I期和II期骨髓瘤患者，第2组包括13例III期MM患者。将他们的血清生化、四环素标记骨组织形态计量学和骨密度计量学与年龄和性别匹配的对照组进行比较。MM患者表现出骨吸收指数增加，（P < 0.001，与对照组相比），并且在较小程度上增加骨形成指数（P < 0.01，与对照组相比）。2组腰椎、股骨颈和全身骨密度（BMD）均低于1组（P < 0.05）。治疗12个月后，腰椎BMD降低6.6%（95% CI，2.7%至-9.3%），股骨颈BMD降低9.5%（95% CI，-3.2%至-15.9%）。在逐步回归分析中，累积泼尼松龙剂量（B Coef. = -0.39; P = 0.03）和浆细胞浸润（B Coef. = -0.08; P = 0.05）是腰椎骨丢失最重要的预测因子，而血清副蛋白（B Coef. = -0.35; P = 0.02）和浆细胞浸润（B Coef. = -0.20; P = 0.04）是股骨颈骨丢失的最重要预测因素。我们得出的结论是MM的特征是高骨转换，伴有成骨细胞-破骨细胞解偶联。疾病活动性和高剂量糖皮质激素治疗可能是MM持续性骨丢失的原因。
It is unknown whether bone changes which can occur in multiple myeloma (MM) are due to cytokine-induced osteoclastic bone resorption from a clone of abnormal plasma cells or high-dose glucocorticoid therapy.We studied 25 MM patients treated for 1-12 gears with combination chemotherapy, subdivided into two groups. Group 1 consisted of 12 patients with stage I and II myeloma and group 2 consisted of 13 patients with stage III MM. Their serum biochemistry, tetracycline-labelled bone histomorphometry and bone densitometry were compared to age- and sex-matched controls.Patients with MM demonstrated increased indices of bone resorption (P < 0.001 versus controls) and, to a lesser extent, increased indices of bone formation (P < 0.01 versus controls). No patient had evidence of a mineralization defect.Lumbar spine, femoral neck and total body bone mineral density measurements (BMD) were significantly lower in group 2 compared with group 1 (P < 0.05). Following 12 months of therapy, lumbar spine BMD decreased by 6.6% (95% CI, 2.7% to -9.3%) and femoral neck BMD decreased by 9.5% (95% CI, -3.2% to -15.9%). In a stepwise regression analysis, cumulative prednisolone dosage (B Coef. = -0.39; P = 0.03) and plasma cell infiltrate (B Coef. = -0.08; P = 0.05) were the most important predictors of lumbar spine bone loss, whereas serum paraprotein (B Coef. = -0.35; P = 0.02) and plasma cell infiltrate (B Coef. = -0.20; P = 0.04) were the most important predictors of femoral neck bone loss.We conclude that MM is characterized by high bone turnover with osteoblast-osteoclast uncoupling. Both disease activity and high-dose glucocorticoid therapy may be responsible for the ongoing bone loss seen with MM.