多发性骨髓瘤合并胸腔积液的临床观察

Malignant pleural effusion of multiple myeloma

目的 探讨多发性骨髓瘤（MM）合并胸腔积液的临床特点、预后及治疗方法.方法 2005年6月至2010年3月共收治162例MM患者,其中15例合并胸腔积液,男8例,女7例,中位年龄56.8（37～68）岁.所有患者胸腔积液的诊断依靠体格检查、胸部X线检查、胸腔积液脱落细胞学检查.按照国际分期系统（ISS）及Dufie-Salmon分期系统进行分期.结果 15例患者中13例胸腔积液脱落细胞学检查找到骨髓瘤细胞,另有2例反复胸腔积液找脱落细胞均阴性.对以上患者采用含有硼替佐米、大剂量糖皮质激素及顺铂、环磷酰胺、依托泊苷、泼尼松的DECP方案进行治疗,胸腔积液虽有一定控制,但均很快复发.11例患者死亡,2例目前疾病尚稳定,2例失访.结论 MM合并胸腔积液的患者治疗效果差,骨髓瘤性胸腔积液被认为是疾病终末期或预示疾病急剧进展的表现.

Objective To investigate the clinical characteristics, prognosis and treatment of pleural effusion of multiple myeloma. Methods From Jun 2005 to March 2010, of 162 patients with multiple myeloma treated in our department were complicated with pleural effusion, whose the proportion male to female was 8：7 and the median age was 56.8 （37-68） years. The diagnosis of malignant pleural effusion was dependent on physical examination, chest X ray, pleural aspiration and pleural fluid cytology. According to internatinal system stages and Durie-Salmon stages, the patients were staged. Results The results of pleural fluid cytology showed that the myeloma cells were positive in 13 patients and was negative in the other 2 patients. All patients received the chemotherapy regimen including bortezomib, large dose of glucocorticoids and cisplatin, cyclophosphamide, etoposide or prednisone （DECP）. Although pleural effusion was controlled in some degrees, but were quickly relapsed. Eleven patients died, 2 of steady disease and 2 follow-up. Conclusion Multiple myeloma with myelomatous pleural effusion was very poor in the prognosis. Myelomatous pleural effusion was taken as a late manifestation in multiple myeloma or prediction of the aggressive behavior of the disease.