Bauduer F, Delmer A
Service des maladies du sang, CH Côte basque, Bayonne, France.
Bull Cancer. 1996 Jul;83(7):542-7.
Osteolytic lesions in multiple myeloma are related to osteoclast activation induced by a network of cytokines including IL6, TNF beta or IL1 beta which explain pain, fractures, or hypercalcaemia appearance. Bone destruction is reflected by hydroxyprolinuria and inversely correlated with serum osteocalcin. Lytic lesions or osteopenia are present in 80% of patients on X-ray. MR imaging, is interesting for exploring spinal lesions or the so-called solitary plasmacytomas but still remains a tool in evaluation. After therapies few modifications are demonstrated on roetgenograms while osteodensitometry appears more sensitive. A review of the literature is made showing the prominent place of clodronate in the therapy of hypercalcaemia of multiple myeloma. This drug appears attractive for decreasing osteolysis and perhaps for improving quality of life of patients. Nevertheless, a better definition of its use in clinical practice is necessary.
多发性骨髓瘤中的溶骨性病变与包括白细胞介素6、肿瘤坏死因子β或白细胞介素1β在内的细胞因子网络诱导的破骨细胞活化有关，这些细胞因子解释了疼痛、骨折或高钙血症的出现。骨破坏通过羟脯氨酸尿反映出来，并且与血清骨钙素呈负相关。80%的患者在X射线上出现溶骨性病变或骨质减少。磁共振成像对于探索脊柱病变或所谓的孤立性浆细胞瘤很有意义，但仍然只是一种评估工具。治疗后，X线片上显示的变化很少，而骨密度测定似乎更敏感。对文献进行了综述，显示氯膦酸盐在多发性骨髓瘤高钙血症治疗中的突出地位。这种药物对于减少骨溶解以及可能改善患者生活质量似乎很有吸引力。然而，有必要更好地界定其在临床实践中的用法。
