多发性骨髓瘤血液透析患者的临床特征与生存状况研究

Study on the clinical characteristics and survival of hemodialysis patients with multiple myeloma

目的探讨多发性骨髓瘤血液透析患者的临床特征与生存状况。方法选取2012年1月至2017年1月在该院进行首次血液透析的64例多发性骨髓瘤患者作为观察组,以首次进行血液透析的非多发性骨髓瘤患者128例作为对照组,以年龄、血管通路、首次透析时间进行匹配筛选。收集多发性骨髓瘤患者的临床资料,包括确诊为多发性骨髓瘤至首次血液透析的时间、异常免疫球蛋白分型、国际分期系统(ISS)分期、化疗方案及化疗疗效;收集多发性骨髓瘤与非多发性骨髓瘤患者首次透析时的年龄、性别、血管通路、实验室检查指标、合并基础疾病及肾小球滤过率。比较两组患者的临床资料、生存状况,比较多发性骨髓瘤患者化疗疗效,采用多因素Cox比例风险回归模型对多发性骨髓瘤血液透析患者的生存状况危险因素进行分析。结果多发性骨髓瘤行血液透析患者与非多发性骨髓瘤行血液透析患者比较,血红蛋白水平较低,血钙水平较高,血小板水平较低,合并糖尿病病史患者例数较少。截止随访终止时,观察组患者生存率为34.4%,病死率为65.6%,转肾移植率为0.0%;对照组患者生存率为71.1%,病死率为28.9%,转肾移植率为6.3%。经Kaplan-Meier法比较两组患者的累积生存率差异有统计学意义(P<0.01)。多发性骨髓瘤患者中位生存时间为218d,其中化疗后完全缓解患者中位生存时间为1 253d,部分缓解患者中位生存时间为473d,未达部分缓解患者中位生存时间为112d;经Kaplan-Meier法比较不同化疗疗效患者之间累积生存率差异有统计学意义(P<0.01)。多因素Cox比例风险回归模型分析结果显示,年龄大于或等于65岁、血管通路为导管、血小板低于100×109/L、清蛋白低于30g/L、化疗疗效为未达部分缓解是影响多发性骨髓瘤血液透析患者生存状况的危险因素。结论多发性骨髓瘤行血液透析患者血红蛋白水平较低,血钙水平较高,血小板水平较低,合并糖尿病史患者例数较少,合并肺部感染较多。

Objective To investigate the clinical characteristics and survival status of hemodialysis patients with multiple myeloma.Methods A total of 64 cases multiple myeloma who came to the hospital for the first time on hemodialysis from January 2012 to January 2017 was taken as the observation group,128 cases of non multiple myeloma who underwent the hemodialysis for the first time in the hospital were taken as the control group,the patients were matched and selected by age,vascular access,first dialysis time.The clinical data of patients with multiple myeloma were collected,including the diagnosis of multiple myeloma to the first hemodialysis time,abnormal immunoglobulin type,international staging system（ISS）staging,chemotherapy plan,chemotherapy efficacy;the age,gender,vascular access,laboratory examinations,complicated basic diseases and glomerular filtration rate at the first dialysis in patients with multiple myeloma and non multiple myeloma were collected.The clinical data and survival status between the two groups were compared,and the chemotherapy effect of multiple myeloma patients was compared.The risk factors of the survival status of the patients with multiple myeloma were analyzed by the multiple factor Cox proportional risk regression model.Results Compared with non multiple myeloma patients,hemodialysis patients with multiple myeloma had lower hemoglobin level,higher blood calcium level,lower platelet level,and fewer cases with diabetes history.At the end of the follow-up,the survival rate of the patients in the observation group was 34.4%,the mortality rate was 65.6%,and the rate of renal transplantation was 0.0%;the survival rate of the control group was71.1%,the mortality rate was 28.9%,and the rate of renal transplantation was 6.3%.The cumulative survival rate between the two groups was statistically significant by Kaplan-Meier（P〈0.01）.The median survival time of the patients with multiple myeloma was 218 d,of which the median survival time of the patients with complete remission after chemotherapy was 1 253 d,the median survival time of patients with partial remission was 473 d,the median survival time of patients without partial remission was 112 d,the cumulative survival rate of patients with different chemotherapy effects was statistically significant by Kaplan-Meier（P〈0.01）.The results of multiple factor Cox proportional risk regression model showed that patients greater than or equal to 65 years old,vascular access as the catheter,the platelet100×109/L,albumin level30 g/L,chemotherapy not reaching partial remission were risk factors for survival in hemodialysis patients with multiple myeloma.Conclusion The hemoglobin level of the hemodialysis patients with multiple myeloma is low,the level of blood calcium is higher,the level of platelet is low,the number of patients with diabetes history is less,but complicated the pulmonary infection occured more.Patients greater than or equal to 65 years old,vascular access as the catheter,the platelet100×109/L,albumin level30 g/L,chemotherapy not reaching partial remission are risk factors for survival in hemodialysis patients with multiple myeloma.