以腰痛为首发表现的多发性骨髓瘤25例误诊分析

Misdiagnosis analysis of 25 cases of multiple myeloma presented initially as lumbago

目的分析以腰痛为首发表现的多发性骨髓瘤（MM）患者的误诊原因、防治方法。方法收集我院血液科25例MM患者临床资料进行回顾性分析，分析其临床表现、误诊及治疗与预后情况。结果以腰痛为首发表现的25例患者多误诊为骨关节疾病，其中腰椎间盘突出6例，腰椎压缩性骨折7例，骨质疏松6例；误诊骨结核1例，类风湿关节炎3例；另有2例误诊为骨转移瘤，以后逐渐出现贫血、白细胞减少、血小板减少、肾功能损害等才确诊为MM并进行治疗。误诊时间3—13个月，平均误诊时间为7个月。本组患者生存时间为（29．2±5．2）个月。结论以腰痛为首发表现的MM临床表现单一，易误诊为骨关节疾病，非血液专科医生应提高对本病的认知度及警惕性，结合辅助检查结果，总结经验教训，以提高本病的早期诊断，从而有效提升患者的预后及生活质量。

Objective To identify the reason and preventive methods from misdiagnosed cases of multiple myeloma（MM） initially manifested as lumbago. Methods Medical history and clinical data of 25 MM patients in department of hematology in our hospital were retrospectively analyzed to explore the clinical characteristics, misdiagnosis and prognosis of them. Results The 25 patients with initial presentation of lumbago were most misdiagnosed as bone and joint diseases, including 6 cases of lumbar disc, 7 cases of lumbar compression fractures, 6 cases of osteoporosis. And 1 cases of bone tuberculosis, 3 patients of rheumatoid arthritis. And there were 2 cases of bone metastases, who were later diagnosed when anemia, neutropenia, thrombocytopenic and renal dysfunction appeared. The average misdiagnosed time was 7 months with a range of 3 months to 13 months. The median survival time was （ 29. 2 ＋ 5.2 ） months in this group of patients. Conclusion MM, with the first manifestation of lumbago, has a single clinical manifestation and is often misdiagnosed as bone and joint diseases. Specialists who are not from hematology department should raise awareness and vigilance of the disease. Laboratory examinations results should be referred to in the diagnosis. Sum up experience in order to improve the early diagnosis of this disease and to effectively improve patient＇s prognosis and quality of life.