多发性骨髓瘤骨病的临床特点分析

The Clinical features of myeloma bone disease

目的 总结多发性骨髓瘤（MM）患者骨病（MBD）的临床特点.方法 回顾性分析205例MM患者MBD的临床特点,比较不同MBD分级患者的临床疗效及MBD分级与预后的关系.结果 ①205例患者中以骨痛为首发症状的患者150例（73.2%）;②204例患者根据X线片检查进行MBD分级：O级23例（11.3%）、1级14例（6.9%）、2级23例（11.3%）、3级68例（33.3%）、4级76例（37.2%）.③MBD 2～4级患者的ECOG评分、骨髓浆细胞比例、CD138＋ CD38＋ 细胞比例、血清IL-6水平明显高于0～1级患者（P值均〈0.05）,而4级患者低钙血症的发牛率明显高于0～3级患者（P=0.038）.④不同MBD分级患者诱导治疗反应各组间比较差异均无统计学意义（P值均〉0.05）.⑤单因素分析显示MBD 2～4级患者的疾病进展时间（TrP）短于0～1级患者（P=0.029）.⑥多因素分析发现溶骨性损害并不是独立预后因素（P=0.825）.结论 骨骼疼痛及溶骨性损害在我国MM患者中的发生率高,利用影像学进行MBD分级显示发生溶骨性损害（2～4级）的患者中反应MM肿瘤负荷及疾病严重程度的多种指标明显高于未发生溶骨性损害的患者（0～1级）.2～4级患者TTP显著短于0～1级患者.

Objective To analyze the clinical features of patients with newly diagnosed myeloma bone disease （ MBD）.Method Clinical features of MBD in two hundred and five patients with newly diag-nosed multiple myeloma （MM） were analyzed retrospectively.The relationship between outcome of different grades of MBD patients and their prognosis was compared.Results ①Among the 205 patients, one hundred and fifty （72.7% ） had bone pain as the first symptom.②According to X-ray evaluation, there were 23 （11.3%） of grade 0, 14（6.9%） grade 1, 23（11.3%） of grade2, 68（33.3%） grade 3 and 76（37.2% ） grade 4.③Patients with grade2-4 MBD had significantly higher ECOG performance score, marrow plasma-cytes, marrow CD138＋ CD38＋cell percentage and serum IL-6 level than those with grade 0 - 1 did （P〈0.05）.Patients with grade 4 MBD presented with hypocalcemia （P〈0.05） more often than those with grades 0-3 diseases did.④There was no significant difference in response to initial induction chemotherapy among the five groups （P =0.642）.⑤Univariate analysis demonstrated that the time to progression （TTP） in grade 2-4 MBD groups was significantly shorter than that in grade 0 - 1 groups （P = 0.029）.⑥Multivari-able COX analysis did not indicate lytic bone changes was a independent prognostic factor for OS and TTP.Conclusion There is a rather high incidence of MBD in MM patients in China.Patients with extensive X-ray bone lesions have more severe hematologic parameters than those without bone lesions did, and severe bone lesions is an important adverse prognostic factor for TTP.