多发性骨髓瘤骨病治疗中颌骨坏死风险的研究进展

Research Progress on the Risk of Osteonecrosis of the Jaw in the Treatment of Multiple Myeloma Bone Disease

摘要: 多发性骨髓瘤骨病是多发性骨髓瘤的核心并发症，临床以骨靶向药物联合化疗为主要治疗手段，在有效控制骨相关事件的同时，易引发药物相关性颌骨坏死，严重影响患者的治疗依从性与生活质量。本文围绕多发性骨髓瘤骨病的发病机制、治疗现状展开阐述，从药物作用、局部刺激、全身状况及疾病本身等层面分析颌骨坏死的发生机制与危险因素，系统梳理颌骨坏死的规范化预防、早期识别、临床治疗、中医药辅助及综合管理策略。研究显示，颌骨坏死是多因素共同作用的结果，通过口腔预处理、用药监测、早期预警指标筛查及多学科联合干预，可显著降低其发生风险。中医药在调节骨代谢、促进组织修复、减轻不良反应方面具有独特优势，与西医方案协同应用有助于提升防控效果。构建全程化、个体化的综合防控体系，对改善多发性骨髓瘤患者的长期预后具有重要的临床意义。

Abstract: Multiple myeloma bone disease is a core complication of multiple myeloma. Clinically, the main treatment approach is the combination of bone-targeting drugs and chemotherapy. While effectively controlling bone-related events, it is prone to cause drug-related osteonecrosis of the jaw, which seriously affects the treatment compliance and quality of life of patients. This article elaborates on the pathogenesis and current treatment status of multiple myeloma bone disease, analyzing the mechanism and risk factors of osteonecrosis of the jaw from the aspects of drug action, local stimulation, overall condition, and the disease itself. It systematically reviews the standardized prevention, early identification, clinical treatment, traditional Chinese medicine assistance, and comprehensive management strategies for osteonecrosis. The research shows that osteonecrosis is the result of multiple factors acting together. By means of oral pre-treatment, medication monitoring, early warning indicator screening, and multidisciplinary joint intervention, the risk of its occurrence can be significantly reduced. Traditional Chinese medicine has unique advantages in regulating bone metabolism, promoting tissue repair, and reducing adverse reactions. When used in conjunction with Western medicine, it helps to improve the prevention and control effect. Establishing a comprehensive and individualized prevention and control system is of great clinical significance for improving the long-term prognosis of patients with multiple myeloma.