84例多发性骨髓瘤骨病发病及其相关因素研究

The Incidence and Risk Factors of Osteopathia in Patients with Multiple Myeloma

目的:探讨多发性骨髓瘤(MM)骨病发病及其相关因素。方法:统计1983年1月至2007年6月确诊的84例MM患者骨病发病率,并对性别、年龄以及血清白蛋白、球蛋白、β2-微球蛋白、M蛋白、血钙、血磷、C-反应蛋白、尿酸、肌苷、尿素氮,骨髓浆细胞比例等骨病发生相关因素进行分析。结果:1)MM骨病发生率83.3%;按骨病类型统计溶骨性病变发生率60.9%、病理性骨折为32.8%,二者有统计学差异(P<0.05);按骨病发生部位统计,颅骨骨病发生率58%、肋骨骨病发病率42.0%,均高于四肢长骨(20.3%)(P<0.05)。2)实验室检查:MM骨病患者血清白蛋白平均为33.13±6.09g/L、不伴骨病者为39±4.38g/L,有统计学差异(P<0.05);伴有骨病的MM患者血清β2-微球蛋白平均为8.11±5.64mg/L、不伴骨病者为0.953±0.34mg/L,有统计学差异(P<0.05);伴有骨病的MM患者血清球蛋白平均为53.40±28.39g/L、不伴骨病者为33.09±20.02g/L,有统计学差异(P<0.05);骨髓分类有不成熟浆细胞者骨病发生率96.1%、无不成熟浆细胞者为81.3%,有统计学差异(P<0.05);伴有骨病的IgG型MM患者血清IgG平均为6818.64±2822.57mg/dL、不伴骨病者为2425.5±1430.48mg/dL,有统计学差异(P<0.05);伴有骨病的MM患者血钙平均为4.86±3.19mmol/L、不伴骨病者为1.93±0.37mmol/L,有统计学差异(P<0.05);伴有骨病的MM患者血尿酸平均为392.59±171.61umol/L、不伴骨病者为242.5±219.45umol/L,有统计学差异(P<0.05)。3)多因素分析:球蛋白和β2-微球蛋白是MM骨病发病的危险因素。结论:骨病是MM的常见并发症,以II期、III期MM多见,扁骨受累多见,骨质疏松和溶骨性改变多见,且主要与肿瘤负荷有关。

Objective： To investigate the incidence and risk factors of osteopathia in patients with multiple myeloma（MM）. Methods： To retrospect 84 patients with MM seen in our department since January 1983. The incidence of osteopathia in the 84 cases was calculated and several correlation factors were analyzed, including gender, age, seralbumin, seroglobulin, β2-microglobulin, M-protein, blood calcium, blood phosphonium, C-reactive protein, uric acid, carnine, urea nitrogen, and plasma cell proportion in bone marrow. Results： 1）The incidence of osteopathia in these 84 patients was 83.3%. There were 60.9% patients with osteolysis and 32.8% with pathological fracture. The cranial bone was involved in 58.0% patients; the costal bones were involved in 42.0% patients; and the long bones of extremities were involved in 20.3% patients. 2）The seralbumin level was 33.13±6.09g/L in patients with osteopathia and 39±0.38g/L in patients without osteopathia（P〈0.05）. The β2-microglobulin level was 8.1 l±0.64mg/L versus 0.953±0.34mg/L（P〈0.05）. The seroglobulin level was 53.40±8.39g/L versus 33.09±0.02g/L （P〈0.05）. The blood calcium level was 4.86±0.19 mmol/L versus 1.93± 0.37mmol/L（P〈0.05）. The uric acid level was 392.59±71.61umol/L versus 242.5±19.45umol/L（P〈0.05）. Moreover, the incidence of osteopathia was 96.1% in patients with immature plasma cells and 81.3% in patients without immature plasma cells（P〈0.05）. In patients of IgG type, the average serum IgG level was 6818.64±822.57mg/dL in patients with osteopathia and 2425.5±430.48mg/dL in patients without osteopathia （P〈0.05）. 3）High globulin and β2-microglobulin levels in serum were risk factors of osteopathia in patients with MM. Coneluslon： Osteopathia is a common complication of MM, which is more frequently seen in phase Ⅱ or phase Ⅲ of MM. Flat bones are frequently involved, often resulting in osteoporosis and osteolysis, and predominantly correlated with tumor burden.