138例不同首发症状的多发性骨髓瘤临床回顾性分析

Clinical retrospective analysis of 138 cases of multiple myeloma

目的：分析多发性骨髓瘤与非多发性骨髓瘤患者以相同症状首次就诊时常规实验室检查指标的显著性差异，提示非血液科医生尽早排查多发性骨髓瘤，减少多发性骨髓瘤的误诊与漏诊。方法：回顾性分析2013.2-2016.12武汉大学人民医院确诊138例多发性骨髓瘤患者的临床特征。以肾功能不全（血肌酐≥177umol/L），感染，骨痛，贫血四大首发症状分组，分别设立对照组（首发临床症状相同的非骨髓瘤患者），采用SPSS22.0及Medcalce 15.10软件分析多发性骨髓瘤与非多发性骨髓瘤患者常规实验室检查指标的显著性差异和诊断阈值。结果：1.首次就诊时血肌酐≥177umol/L，原因不明的肾功能不全患者出现血Ca〉2.39mmol/L＋ALB≤30.31g/L＋Hb≤84g/L，建议排查多发性骨髓瘤。2.常规治疗效果不佳，原因不明的感染患者出现IgM〈0.42g/L ＋ ALB≤32.7g/L；ESR〉 82 mm/h；Hb〈100g/L三项之二，建议排查多发性骨髓瘤。3. 首发症状为骨关节疼痛合并骨质损害的男性患者存在尿蛋白及潜血阳性，并出现Ca〉2.39mmol/L ＋ ALB〈37.5g/L ＋ Hb〈104g/L ＋ TT〉19.8sec时建议排查多发性骨髓瘤。4. 男性患者，难以纠正，原因不明的贫血，Hb≤90g/L出现IgM〈0.51g/L＋ALB〈34.1g/L＋GLB〉46.4g/L时建议排查多发性骨髓瘤。结论：多发性骨髓瘤是一种恶性浆细胞病，由于累及多系统、多脏器，起病时血液系统症状不典型，血液系统外的症状多样化，导致在首诊过程中很容易误诊及漏诊。在肾功能不全，感染，骨痛，贫血的基础上，常规实验室检查提示高血钙，低IgM，低白蛋白，高球蛋白时，建议骨髓穿刺活检排查多发性骨髓瘤。早期诊断，规范治疗是提高多发性骨髓瘤患者生存质量及生存时间的关键。

Objective To analysis of multiple myeloma （MM） and non-MM patients with the same clinical manifestations but significant differences in laboratory findings at the first visit to the Emergency Medicine Department suggesting that patient should be rule out the possibilities of suffering from MM by the attending physicians engaging in a specialty other than hematology as soon as possible to avoid misdiagnosis of MM. Methods Retrospective analysis of clinical features of MM cases from February 2013 to December 2016. Patients with renal dysfunction （serum creatinine ≥177 mmol/L）, infection, bone pain and anemia were divided into four groups. The non-MM patients with the same clinical symptoms were enrolled as control group. SPSS22. 0 and Medcalce 15.10 software were used for analyzing the distinct difference and diagnostic validity of routine laboratory tests in patients with MM and non-MM. Results ①The patients with serum creatinine≥177 mmol/L, and unexplained renal insufficiency with blood Ca2＋ 〉 2. 39mmol/L, ALB ≤ 30. 31 g/L and Hb≤84 g/L should be investigated the possibility of MM. ②The patient with poor response to the conventional treatment and unexplained infection with IgM 〈 0.42 g/L and ALB ≤ 32.7 g/L or ESR 〉 82 mm/h and Hb 〈 100 g/L should be investigated the possibility of MM.③The male patients with the first symptom in bone and joint pain associated with bone damage with urinary protein and blood, and the emergence of Ca2＋〉 2. 39 mmol/L, ALB 〈 37. 5 g/L, Hb 〈 104 g/L and TT〉 19. 8 s were suggested to detect MM. ④The poor respose to conventional treatment, unexplained anemia （Hb≤90 g/L）, IgM 〈0. 51 g/L, ALB 〈 34. 1 g/L and GLB 〉 46. 4 g/L suggested to detect MM. Conclusions On the basis of symptoms such as renal insufficiency, infection, bone pain, anemia, routine blood .laboratory findings of high calcium, low IgM, low albumin, and high globulin, it was recommended that bone marrow biopsy be made to detect MM.