合并肾损害的多发性骨髓瘤患者临床特点及预后

摘要

目的 探讨合并肾功能损害的多发性骨髓瘤(MM)患者的临床特点及预后.方法 将90例初诊MM患者分为肾功能正常组(血肌酐<133μmol/L)51例、肾功能损害组(血肌酐≥133μmol/L)39例,回顾性分析两组的临床资料及随访结果,比较两组的临床特点及预后,分析影响MM患者预后的危险因素.结果 肾功能正常组的红细胞分布宽度水平高于肾功能损害组(P<0.05),而平均动脉压、超敏C反应蛋白(hs-CRP)、血沉、尿酸、血钙、血β2微球蛋白水平及蛋白尿者比例低于肾功能损害组(P<0.05).肾功能正常组血肌酐翻倍事件及终末期肾病发生率、死亡者比例均低于肾功能损害组(P<0.05),肾功能正常组血肌酐翻倍、终末期肾病、死亡中位发生时间均长于肾功能损害组(P<0.05).血钙、平均动脉压、hs-CRP水平升高及肾功能损害是MM患者生存预后的危险因素(P<0.05).结论 合并肾功能损害的MM患者具有不同的临床特点,预后更差.%Objective To investigate the clinical characteristics and prognosis of patients with multiple myeloma ( MM) complicated with renal damage.Methods Ninety patients initially diagnosed as MM were divided into normal renal function group ( serum creatinine<133 μmol/L,n=51) and renal damage group(serum creatinine≥133 μmol/L,n=39).The clinical data and follow-up results of both groups were retrospectively analyzed.The clinical characteristics and prognosis were compared between the two groups.The risk factors influencing the prognosis of MM patients were analyzed.Results In the normal renal function group ,the red blood cell distribution width was higher(P<0.05),but the mean arterial pressure,levels of high-sensitivity C-reactive protein(hs-CRP),erythrocyte sedimentation rate,uric acid,blood calcium and blood β2 microglobulin,and proportion of proteinuria cases were lower compared to the renal damage group(P<0.05).The incidence rates of serum creatinine level doubling and end-stage renal disease,and proportion of death were lower in the normal renal function group compared to the renal damage group (P<0.05).The durations for the incidence of serum creatinine level doubling,end-stage renal disease and death were longer in the normal renal function group compared to the renal damage group (P<0.05). Renal damage and elevated levels of blood calcium , mean arterial pressure and hs-CRP were the risk factors for the prognosis of MM patients(P<0.05).Conclusion The MM patients complicated with renal damage have different clinical characteristics and worse prognosis.