邵雯, 周晓霜. 合并肾功能损害的多发性骨髓瘤患者临床特征分析[J]. 临床肾脏病杂志, 2020, 20(4): 282-286. DOI: 10.3969/j.issn.1671-2390.2020.04.004
    引用本文: 邵雯, 周晓霜. 合并肾功能损害的多发性骨髓瘤患者临床特征分析[J]. 临床肾脏病杂志, 2020, 20(4): 282-286. DOI: 10.3969/j.issn.1671-2390.2020.04.004
    SHAO Wen, ZHOU Xiao-shuang. Clinical features of patients with multiple myeloma complicated with renal impairment[J]. Journal of Clinical Nephrology, 2020, 20(4): 282-286. DOI: 10.3969/j.issn.1671-2390.2020.04.004
    Citation: SHAO Wen, ZHOU Xiao-shuang. Clinical features of patients with multiple myeloma complicated with renal impairment[J]. Journal of Clinical Nephrology, 2020, 20(4): 282-286. DOI: 10.3969/j.issn.1671-2390.2020.04.004

    合并肾功能损害的多发性骨髓瘤患者临床特征分析

    Clinical features of patients with multiple myeloma complicated with renal impairment

    • 摘要: 目的 分析多发性骨髓瘤(multiple myeloma,MM)患者的临床资料特点,提高MM伴肾损害的早期诊断水平,以防漏诊、误诊。方法 回顾性分析就诊于山西医科大学附属人民医院血液科及肾内科的多发性骨髓瘤患者资料,根据国际骨髓瘤工作组的诊断标准及全球肾脏病预后组织的急慢性肾损害标准,将患者分为肾功能正常组和肾功能损害组,分析两组患者一般临床资料及实验室指标的差异。结果 共纳入MM患者296例,肾功能损害组患者95例(32.1%),平均年龄61.42岁,男女比例为2.06:1,血清免疫固定电泳显示以免疫球蛋白G和免疫球蛋白A型为主。两组患者年龄、性别、血清白蛋白、血κ链总量、血λ链总量无明显差异,但肾功能损害组β2微球蛋白(β2-microglobulin,β2-MG)、乳酸脱氢酶(lactic dehydrogenase,LDH)、高钙血症发生率明显高于肾功能正常组,肾功能损害组血红蛋白浓度低于肾功能正常组。肾功能损害组中,血β2-MG、LDH水平与肾小球滤过率呈负相关。多因素分析结果提示MM患者发生肾功能损害的风险随β2-MG、LDH及血钙升高增加。结论 高β2-MG、LDH水平及高钙血症是MM合并肾功能损害的危险因素,在临床中使用传统检测指标同时关注β2-MG、LDH、血钙结果有助于发现早期肾损害。

       

      Abstract: Objective To analyze the clinical data of patients with multiple myeloma (MM) complicated with renal impairment, and to improve the early diagnosis level of MM complicated with renal impairment to avoid missing diagnosis and false diagnosis.Methods The clinical data of the patients, who were diagnosed as MM in department of hematology and department of nephrology of Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, were retrospectively analyzed. According to the diagnostic criteria of acute and chronic renal damage which were developed by International Myeloma Working Group (IMWG) and Kidney Disease Improving Global Guideline Organization (KDIGO), the patients were divided into normal renal function group and abnormal renal function group. The differences of Clinical features between the two groups were analyzed.Results A total of 296 patients with multiple myeloma were enrolled in this study, and included 95 cases (32.1%) complicated with renal impairment. The average age of the abnormal renal function group was 61.42 years, and the ratio of men to women was 2.06:1, besides, the serum immunofixation electrophoresis was performed mainly on IgG and IgA. There were no significant differences in age, sex, serum albumin, and total blood κ chain between the two groups. But the incidences of high blood β2-microglobulin(β2-MG), high blood lactate dehydrogenase (LDH) and hypercalcemia in the abnormal renal function group were significantly higher than those in the normal renal function group, however the hemoglobin concentration in the abnormal renal function group was lower than that in the normal renal function group. In abnormal renal function group, blood β2-MG and LDH levels were negatively correlated with glomerular filtration rate (GFR). The results of multivariate analysis suggested that the risk of renal function impairment in the patients with MM was increased with the increase of β2-MG, LDH and blood calcium. Conclusions The high levels of β2-MG, LDH and blood calcium in patients with MM are risk factors for MM with renal function impairment. In the meanwhile of application of the traditional test indices, concern about β2-MG, LDH and blood calcium may help detect early renal impairment.

       

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