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多发性骨髓瘤合并肾功能损害临床特征及其影响患者预后的相关因素
张天琰,张鹂,吴秋慧,阳梅
0
(四川大学华西医院血液内科)
摘要:
目的 分析多发性骨髓瘤(MM)合并肾功能损害患者临床特征以及患者预后影响因素。方法 回顾性分析2015年5月~2017年5月在我院治疗206例MM合并肾功能损害患者相关资料,分析患者临床特征、预后情况,随后对预后相关因素进行单因素与多因素Logistic回归分析。结果 所有患者中 有管型肾病、淀粉样变以及其他病变类型分别为108例、68例以及30例;管型肾病患者DS分期主要为Ⅲ期,淀粉样变患者DS分期主要为Ⅰ期,其他病变类型同样为Ⅲ期,三种肾脏疾病类型DS分期差异具有统计学意义(P<0.05);三组患者中淀粉样变患者血红蛋白水平显著高于另两组(P<0.05),血清白蛋白水平和骨髓浆细胞比例:管型肾病>其他病变类型>淀粉样变,24 h蛋白尿:淀粉样变>管型肾病>其他病变类型,三种肾脏疾病患者血清白蛋白水平、骨髓浆细胞比例、24 h蛋白尿之间比较具有统计学意义(P<0.05);管型肾病患者血肌酐水平显著高于另两组(P<0.05);管型肾病患者体内检出免疫球蛋白类型为不分泌型,而淀粉样变和其他病变类型患者检出免疫球蛋白主要为IgG型,三种肾脏疾病类型免疫球蛋白类型差异具有统计学意义(P<0.05);三种肾脏疾病患者单克隆轻链主要为λ型。206例患者中有4例患者在随访时间失访,202例患者2年累积生存率为891%,其中管型肾变、淀粉样变以及其他类型患者2年累积生存率分别为87.7%,91.0%与89.7%;患者白细胞计数、血红蛋白、血白蛋白、骨髓浆细胞比例、血β2微球蛋白、血小板、DS分期与ECOG评分与患者预后情况存在相关性(P<0.05),性别、年龄、24h蛋白尿、血肌酐以及血钙水平等与患者预后情况没有相关性(P>0.05);多因素Logistic回归分析结果显示,血β2微球蛋白水平、ECOG评分、骨髓浆细胞比例升高,血白蛋白水平下降以及DS分期为患者预后不佳危险因素(P<0.05)。结论 多发性骨髓瘤合并肾功能损害患者肾脏病变主要以管型肾变为主,单克隆轻链主要为λ型,而血β2微球蛋白水平、ECOG评分、骨髓浆细胞比例升高,血白蛋白水平下降与DS分期为导致患者预后不佳危险因素。
关键词:  多发性骨髓瘤  肾功能损害  临床特征  预后影响因素
DOI:
基金项目:
Clinical features of multiple myeloma with renal function damage and related prognostic factors
ZHANG Tianyan,ZHANG Li,WU Qiuhui,YANG Mei
(Department of Hematology, West China Hospital, Sichuan University)
Abstract:
Objective To analyze the clinical features of patients with multiple myeloma (MM) complicated with renal function damage and prognostic factors of patients. Methods The related data of 206 patients with MM complicated with renal function damage treated in our hospital from May 2015 to May 2017 were retrospectively analyzed. Clinical features and prognosis of patients were analyzed. Factors related to the prognosis were analyzed by univariate and multivariate Logistic regression analyses. Results There were 108 cases (52.43%) with cast nephropathy, 68 cases (33.01%) with amyloidosis and 30 cases (14.56%) with other lesions. The main DS stages of patients with cast nephropathy, patients with amyloidosis and patients with other lesions were stage Ⅲ, stage Ⅰ and stage Ⅲ, respectively (P<0.05). The hemoglobin level in patients with amyloidosis was significantly higher than that in the other two groups (P<0.05). The serum albumin levels and ratio of bone marrow plasma cells ranking from high to low was as follows: cast nephropathy, other lesions and amyloidosis. 24h proteinuria ranking from high to low was as follows: amyloidosis, cast nephropathy and other lesions. There were significant differences among the three groups (P<0.05). The serum creatinine level in patients with cast nephropathy was significantly higher than that in the other two groups (P<0.05). The main type of immunoglobulin detected in patients with cast nephropathy was nonporous type, while immunoglobulins detected in patients with amyloidosis and other types of lesions mainly were IgG type (P<0.05). The monoclonal light chain of the three groups mainly was λ type. 8 of the 206 patients were lost to followup during the followup period. The 2year cumulative survival rate of 202 patients was 891%. The 2year cumulative survival rates of patients with tubular nephropathy, amyloidosis and other types of lesions were 877%, 910% and 89.7%, respectively. White blood cell count, hemoglobin, serum albumin, percentage of bone marrow plasma cells, blood β2microglobulin, platelets, DS staging and ECOG score were related to the prognosis of patients (P<0.05). There was no correlation between gender, age, 24h proteinuria, serum creatinine and serum calcium level (P>0.05). Multivariate Logistic regression analysis showed that the blood β2microglobulin level, ECOG score, increased proportion of bone marrow plasma cells, decreased serum albumin level and DS staging were risk factors for poor prognosis (P<0.05). Conclusion The main renal lesion in patients with MM complicated with renal function damage is cast nephropathy. The main type of monoclonal light chain is λ type. Elevated blood β2microglobulin level, ECOG score and the proportion of bone marrow plasma cells and decreased serum albumin levels and DS staging are risk factors for poor prognosis of patients.
Key words:  Multiple myeloma  Renal function damage  Clinical features  Prognostic factors

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