单克隆免疫球蛋白血症合并肾损害患者临床病理特征及预后分析

庄晶; 曲悦; 姜鸿

doi:10.3969/j.issn.1671-2390.2023.09.001

单克隆免疫球蛋白血症合并肾损害患者临床病理特征及预后分析

Clinicopathological features and outcomes of patients with monoclonal immunoglobulinemia complicated with renal damage

摘要

摘要:
目的探讨单克隆免疫球蛋白血症合并肾损害患者临床病理特征并分析预后。
方法纳入2017年1月至2019年6月在新疆维吾尔自治区人民医院就诊的98例单克隆免疫球蛋白血症合并肾损害患者作为研究对象，按临床表现和肾脏病理改变类型将所有患者分为单克隆丙种球蛋白病（monoclonal gammopathy，MGRS）组和多发性骨髓瘤（multiple myeloma，MM）组，比较两组患者临床病理特征以及随访3年无肌酐翻倍事件生存率和总生存率，Cox回归分析分别获得影响MGRS和MM患者预后的独立预测因素。
结果 MGRS组与MM组患者相比，24 h尿蛋白定量（4.5 ± 1.1）g比（3.7 ± 1.1）g，t/χ²=2.456，P=0.024、估算肾小球滤过率（estimated glomerular filtration rate，eGFR）（49.2 ± 8.9）mL·min⁻¹·（1.73 m²）⁻¹ 比（37.6 ± 7.4）mL·min⁻¹·（1.73 m²）⁻¹，t/χ²=8.992，P＜0.001、血红蛋白（74.2 ± 4.8）g/L 比（63.5 ± 6.3）g/L，t/χ²=5.689，P＜0.001、肾病综合征占比（89.1% 比42.3%，t/χ²=8.896，P＜0.001）以及轻链型肾淀粉样变占比（82.6% 比38.5%，t/χ²=9.323，P＜0.001）明显偏高，而男性占比（80.8% 比 54.3%，t/χ²=4.532，P=0.030）、血肌酐（232.4 ± 34.5）μmol/L比（183.2 ± 28.9）μmol/L，t/χ²=5.566，P＜0.001、白蛋白（26.8 ± 3.7）g/L比（20.2 ± 4.0）g/L，t/χ²=3.756，P＜0.001以及轻链管型肾病占比（57.7%比10.9%，t/χ²=9.323，P＜0.001）MM组患者明显高于MGRS组。MGRS组患者随访1年、2年、3年累积无肌酐翻倍生存率分别为93.6%、86.7%、74.3%，明显高于MM组的77.2%、52.4%、42.4%（χ²=4.893，P=0.27），总生存率分别为100%、89.4%、77.5%，明显高于MM组的78.6%、59.1%、57.7%（χ²=5.113，P=0.22）。多因素Cox回归分析显示，eGFR为影响MGRS患者无肌酐翻倍事件生存率的独立预测因素，eGFR和白蛋白为影响MGRS患者总生存率的独立预测因素（P＜0.05），eGFR以及国际预后（international prognosis，ISS）分期为影响MM患者无肌酐翻倍事件生存率的独立预测因素，eGFR、ISS分期以及欧洲肌力功能评定量表评分为影响MM患者总生存率的独立预测因素（P＜0.05）。
结论 MGRS和MM的临床表现和生存预后具有较大差异，MGRS预后较好，无肌酐翻倍事件生存率和总生存率较高，eGFR和白蛋白水平为MGRS的独立预后因素，eGFR、ISS分期以及欧洲肌力功能评定量表评分为MM的独立预后因素。

Abstract:
Objective To explore the clinicopathological features and outcomes of patients with monoclonal immunoglobulinemia complicated with renal damage.
Methods From January 2017 to June 2019, 98 hospitalized patients of monoclonal immunoglobulinemia complicated with renal damage were recruited as research subjects. According to clinical manifestations and renal pathological changes, they were assigned into two groups of monoclonal gammopathy （MGRS） and multiple myeloma （MM）. Clinicopathological characteristics, creatinine free doubling survival and overall survival （OS） were compared between two groups. Cox regression analysis was utilized for obtaining independent predictors of creatinine free doubling survival and OS post-treatment.
Results 24-hour urinary protein （4.5 ± 1.1）g vs （3.7 ± 1.1） g, t/χ²=2.456, P=0.024, estimated glomerular filtration rate （eGFR）（49.2 ± 8.9）mL·min⁻¹·（1.73 m²）⁻¹ vs （37.6 ± 7.4） mL·min⁻¹·（1.73 m²）⁻¹, t/χ²=8.992, P＜0.001, hemoglobin （74.2 ± 4.8） g/L vs （63.5 ± 6.3） g/L, t/χ²=5.689, P＜0.001, proportion of nephrotic syndrome （89.1% vs 42.3%, t/χ²=8.896, P＜0.001） and proportion of light chain renal amyloidosis （82.6% vs 38.5%, t/χ²=9.323, P＜0.001） were significantly higher in MGRS group than those in MM group while proportion of males （80.8% vs 54.3%, t/χ²=4.532, P=0.030）, serum creatinine （232.4 ± 34.5） μmol/Lvs （183.2 ± 28.9） μmol/L, t/χ²=5.566, P＜0.001, albumin （26.8 ± 3.7） g/L vs （20.2 ± 4.0） g/L, t/χ²=3.756, P＜0.001 and light chain tubular nephropathy （57.7% vs 10.9%, t/χ²=9.323, P＜0.001） were significantly higher in MM group than those in MGRS group. And 1/2/3-year cumulative creatinine free doubling survival （93.6%, 86.7%, 74.3% vs 77.2%, 52.4%, 42.4%, χ²=4.893, P=0.27） and OS （100%, 89.4%, 77.5% vs 78.6%, 59.1%, 57.7%, χ²=5.113, P=0.22） were significantly higher in MGRS group than those in MM group. Multifactor Cox regression analysis indicated that eGFR was an independent predictor of creatinine free doubling event survival of MGRS patients. And eGFR and albumin were independent predictors of total survival of MGRS patients （P＜0.05）; eGFR and ISS stage were independent predictors of creatinine free doubling event survival. And eGFR, ISS stage and EGOC score were independent predictors of OS （P＜0.05）.
Conclusion Great differences exist in clinical manifestations and survivals of MGRS/MM patients. MGRS has a better prognosis with higher rates of creatinine free doubling survival and OS. eGFR and albumin are independent prognostic factors of MGRS. And eGFR, ISS stage and EGOC score are independent prognostic factors of MM.

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