多发性骨髓瘤肾损害34例临床特征和相关因素分析

Clinical features and correlate factors of 34 patients with kidney lesion in multiple myeloma

目的:探讨多发性骨髓瘤肾损害的误诊漏诊原因。方法:对34例多发性骨髓瘤患者肾脏损害的临床表现及实验室检查进行统计学分析。结果:肾脏损害的发生率为39.1%(18/46),以慢性肾功能不全最常见。骨髓浆细胞数量和尿本-周蛋白与肾功能损害之间有显著相关关系(P<0.01),贫血、β2-MG及多发性骨损害与肾脏损害有相关关系(P<0.05)。首发症状缺乏特异性,误诊率70.6%。结论:骨髓浆细胞增殖及尿链蛋白产生可能是多发性骨髓瘤肾脏损害的主要原因。对于不明原因的贫血、骨痛、蛋白尿、高球蛋白血症和骨折,应及时进行本-周蛋白、免疫球蛋白及免疫电泳测定,多部位的骨髓穿刺、活检和骨X线摄片,避免误诊漏诊。联合化疗及保护肾功能可提高治疗效果,降低死亡率。

Objective： To investigate the reasons of misdiagnosis and missed diagnosis of kidney injury in multiple myeloma. Methods： Analysis of clinical features and results of laboratory of kidney lesion were carried out in 34 cases of multiple myeloma patients. Results： The incidence of kidney lesion was 52.3% （34/65） , the most common kidney lesion was chronic renal failure. There was a significant correlation between the quantity of bone marrow plasmacyte or urine Bence - Jones protein and renal function （ P 〈 0.01 ）. Anemia, β2 - microglobulin or multiple bone lesion were correlated with kidney damage（ P 〈0.05）. The specificity was lack in the initial symptom. The misdiagnosis rate was 70.6%. Conclusion： Proliferation of bone marrow plasmacyte and the quantity or urine Bence - Jones protein are main causes of kidney lesion in multiple myeloma. For unknown anemia, ostealgia, albuminuria, hyperglobulinemia and fracture, the determination of hence - Jones protein, immunoglobulin and immunoelectropboresia,the multi - position bone marrow puncture, bone marrow biospy and the osteomyelography should be made in time to avoid missed diagnosis. Combination chemotherapy, and keep normal renal function could improve effect and reduce the mortality of multiple myeloma with kidney lesion.