以心力衰竭症状为首发表现的多发性骨髓瘤12例临床分析

Clinical analysis of multiple myeloma with heart failure as initial manifestations

目的探讨以心力衰竭症状为首发表现的多发性骨髓瘤的临床特征及其预后。方法回顾性分析中山大学附属第一医院2003-01-01—2008-07-31入院的12例以心力衰竭为首发表现的多发性骨髓瘤(MM)的病例资料及预后。结果12例以心力衰竭为首发表现的患者中男9例,女3例。年龄48～69岁,平均(58.4±5.2)岁。12例患者均因不同程度的胸闷气促入院,其中伴贫血10例,蛋白尿9例。心电图示:肢导低电压者8例;R波进展不良和ST-T改变患者6例。超声心动图示左心房增大(41.6±4.2)mm10例;室间隔和左室壁均明显增厚伴室壁运动弥漫性减弱8例。平均随访(4.0±3.7)个月,12例患者均死亡。结论MM以心力衰竭为首发表现在临床上较少见,但其病情进展快,预后差。对于合并贫血、蛋白尿等多系统器官受累时要高度怀疑本病。血浆前脑钠肽(pro-BNP)N端和心脏肌钙蛋白水平是MM患者预后判断的敏感标志物。

Objective To explore the clinical feature and prognosis of multiple myeloma with heart failure as initial manifestations. Methods 12 patients of multiple myeloma with heart failure as initial manifestations were analyzed and followed up. Results Twelve patients, 9 men and 3 women, with mean age of 48 - 69 （ 58.4 ± 5.2 ） years older were enrolled. The first symptoms of the patients were almost the same,with different degree of dyspnea and tachypnea. Anaemia and proteinuria were 83.3% and 75% respectively in 12 patients. ECG showed that 8 patients had low voltage in the limb leads, with present poor R wave progression in the precordial leads and ST-T changes in 6 patients. UCG showed that 10 patients had enlarged left atrium （41.6 ± 4. 2 ） mm,8 patients had increased thickness of the interventricular septums and left ventrieular walls as well as diffuse weakness of the wall motion. Followed up for （4.0 ± 3.7 ） months, all of the patients（ 100% ） died. Conclusion Multiple myeloma with heart failure as initial manifestations is rare clinically, but has fast aggravation and bad prognosis. Pro-brain natriuretic peptide（Pro-BNP） and cardiac troponin are subtile markers for judging the prognosis of patients with multiple myeloma.