多发性骨髓瘤患者肾损害临床特征及其相关因素分析

Clinical characteristics and correlative factors analysis of multiple myeloma with renal damage

摘要:

目的了解多发性骨髓瘤(MM)肾损害患者临床特征及其发生的相关因素.方法对经临床、病理明确诊断的MM肾损害患者的临床特征及实验室检查进行统计学分析.结果MM肾损害的发生率为40.9%(18/44),临床症候群以肾功能不全(血肌酐＞177μmol/L)最为常见(77.8%),其次为肾病综合征(16.7%)、无症状尿检异常(5.56%).血清轻链阳性率为72.2%(13/18),尿中轻链阳性率为77.8%(14/18例),均以λ链为主.骨髓浆细胞数量和尿本周蛋白(BJP)与肾功能损害之间有显著相关关系(P＜0.01;P＜0.05),贫血及多发性骨损害与肾脏损害有相关关系(P＜0.05).结论MM伴肾损害患者临床症候群以肾功能不全多见,血清与尿液中轻链以λ为主.骨髓浆细胞增殖及尿轻链蛋白产生可能是多发性骨髓瘤肾脏损害的主要原因.

Abstract:

Objective: To analyze the clinical characteristics and the correlative factors of kidney lesion in 44 cases of multiple myeloma (MM). Methods: From March 1994 to March 2004, 44 patients with MM were diagnosed by clinical characteritics and pathological methods. Analysis of statistics in clinical characteristics and results of laboratory of kidney lesion of this group of patients were carried out. Results: The incidence of kidney lesion was 40.9% (18/44), with 18 patients occurred in 44 cases. Renal insufficiency (Scr＞177.0 μmol/L) was the most frequent syndrome (77.8%), followed by nephrotic syndrome (16.7%) and syndrome of urinary abnormalities (5.56%). Free light chain was detected in serum of 13 (13/18) patients, in urine of 14 (14/18) patients, with λ chain as the dominant type. There was significant correlation between the quantity of bone marrow plasmacyte or urinary Bence-Jones protein and renal functional lesion (P＜0.01, P＜0.05). Anemia or multiple bone lesion was correlated with kidney damage. Conclusions: The most frequent clinical syndrome of MM with renal lesion is renal insufficiency. The λ chain is the dominant type in the serum or urine. Proliferation of bone marrow plasmacyte and the quantity or urinary Benec-Jones protein are main causes of kidney lesion in multiple myeloma.