320例多发性骨髓瘤校正血钙的临床意义

Clinical Significance of Corrected Serum Calcium in 320 Patients with Multiple Myeloma

目的:分析多发性骨髓瘤患者校正血钙的临床意义。方法:检测320例初发多发性骨髓瘤患者的血钙水平,用同时采集静脉血所得血清白蛋白浓度进行校正,分析校正前后血钙浓度的差异。结果:320例多发性骨髓瘤患者血钙浓度为2.34±0.15 mmol/L,校正后血钙浓度为2.6±0.17 mmol/L,高钙血症患者由11.3%升至校正后的23.1%,低钙血症患者由42.8%下降至校正后的7.8%,血钙的正常患者例数增加。Ⅰ、Ⅱ和Ⅲ期病人的血钙水平在经白蛋白校正前后均有显著性差异(P<0.05)。320例MM患者贫血发生率为80%,肾功能不全发生率为20.9%,骨髓瘤骨病发生率为68.8%,贫血、肾功能不全、骨髓瘤骨病患者血钙浓度均高于正常组,且校正后差异更显著。接受化疗的患者220例,中位PFS为15个月,中位OS为20个月,高钙血症患者PFS及OS缩短,校正后PFS及OS明显缩短,具有显著性差异(P<0.001)。结论:校正血钙能更敏感地反映疾病的严重程度,具有更好的预后判断作用。

Objective： To analyze the clinical significance of corrected serum calcium（ CSCa） in patients with multiple myeloma. Methods： The serum calcium levels of 320 patients with initial multiple myeloma were measured and corrected by serum albumin and its levels measured simultaneously. The differences of serum calcium levels were analyzed before and after the correction by serum albumin. Results： There was a significant difference between serum calcium and CSCa in MM patients（ 2. 34 ± 0. 15 vs 2. 6 ± 0. 17 mmol/L）. The constituent ratio of patients with hypercalcemia was from 11. 3% to 23. 1% after correction,the MM patients with hypocalcemia was decreased from42. 8% to 7. 8% after correction,and the patients with normal calcium level were increased. There was a significant difference between serum calcium level and CSCa in Ⅰ,Ⅱ,Ⅲ stages of MM patients respectively（ P〈0. 05）. In the 320 patients,the incidence of anemia was 80%,renal failure was 20. 9%,and myeloma bone disease was 68. 8%.Calcium concentration in both anemia and renal insufficiency was higher than the normal group,and the difference was more significant after correction. In 220 cases of MM receiving chemotherapy,the median progression-free survival（ PFS） was 15 months,and overall survival（ OS） time was 20 months. The PFS and OS time of the patients with hypercalcemia were shortened,and the difference was very significant after correction（ P〈0. 01）. Conclusion： Corrected serum calcium can more sensitively to reflect the diseases serious extent,thus indicating prognosis has better effect.