多发性骨髓瘤椎管内浸润8例临床分析

Clinical Analysis of 8 Multiple Myeloma Patients Complicated with Spinal Infiltration

目的探讨多发性骨髓瘤(multiple myeloma,MM)椎管内浸润的临床特点、诊断及治疗方法。方法回顾性分析于2011-11/2016-10月在作者医院诊治的8例MM合并椎管内浸润患者的临床特点、核磁共振成像(magnetic resonance imaging,MRI)及电子计算机断层扫描(computed tomography,CT)表现、不同治疗方法及疗效。结果 8例MM合并的椎管内髓外浆细胞瘤(extramedullary plasmacytoma,EMP)均发生在胸椎节段。6例患者从感觉双下肢麻木、腰背部疼痛起,在数小时至3d内进展至截瘫状态。经MRI或CT检查诊断为椎管内硬膜外占位性病变。8例中1例放弃治疗。另7例中,3例接受手术及术后化疗者,1例肌力改善,另2例肌力无变化;单纯接受化疗的2例无效;2例接受放疗者,均恢复行走,其中1例肌力恢复至5级,另1例恢复至4级。7例患者治疗过程中均未出现严重不良反应。结论 MM合并椎管内浸润多发生在胸椎节段,病情进展快。MRI可明确病变部位,尽早进行放疗可以改善患者神经功能,尤其是下肢运动功能。

Objective To study the clinical features,diagnosis and treatment of multiple myeloma（MM）complicated with spinal infiltration.Methods A total of 8 MM patients complicated with spinal infiltration were enrolled in this study from November 2011 to October 2016 in author＇s hospital.The clinical records,magnetic resonance imaging（MRI）or computed tomography（CT）scans,different treatments and efficacies of the patients were analyzed retrospectively.Results All the 8 patients had thoracic spinal cord involvement.It was within only a few hours to 3 days that symptoms of backache and numbness of lower limbs progressed to paraplegia for 6 patients.The spinal infiltration by MM was confirmed by MRI,CT and histopathological analysis.Of the 7 patients who received tumor therapy,3 underwent surgery and followed by chemotherapy,consisted of bortezomib-containing regimens or other regimens.The lower limb muscle strength recovered from0 degree to 3 degree for 1 patient,and unimproved for the other 2 patients.Two cases received chemotherapy only,whose muscle strength not improved at all.Two cases who received radiotherapy achieved complete recovery or near complete recovery of the muscle strength.No serious adverse responses were observed of all the 7 patients.Conclusion The thoracic spinal cord is the common site of spinal infiltration by MM,and MRI is the best method of diagnosis.The treatment must be obtained as early as possible,and radiotherapy is the best choice for improvement of nervous function.