15例多发性骨髓瘤早期误诊临床探究及启示

Clinical Exploration and Inspiration of Early Misdiagnosis of15 Cases of Mutiple Myeloma

目的:总结分析多发性骨髓瘤(Multiple Myeloma,MM)的临床资料和实验室特点,增强对该病的认识,降低漏诊和误诊率。方法:对15例确诊MM患者的临床资料和实验室数据进行回顾性分析。结果:15例确诊的MM患者中,贫血13例,肾功能损害10例,骨痛和骨骼疾患3例,肺部感染1例,颅内占位1例,全血细胞减少1例,升主动脉扩张1例,以贫血、肾功能受损和骨折骨痛最多见。骨髓细胞学检查可见浆细胞比例增高,形态呈多样化,可见双核、多核的骨髓瘤细胞。X线或CT检查可见多发性虫蚀样及穿凿样骨质破坏影,密度低,边界清或不清,甚至出现病理性骨折。血清免疫固定电泳检出M蛋白。结论:多发性骨髓瘤多见于中老年人,随人口老龄化发病率逐年上升,其临床表现复杂多样,引起贫血、感染、肾功能损害、骨痛、病理性骨折,甚至局部肿物或占位等罕见临床症状,缺乏特异性,常造成误诊,在实际工作中临床工作人员应加强对MM的认识,掌握其临床表现的复杂特点,对异常的实验室检查结果应加以综合分析,使多发性骨髓瘤能够得到及时确诊和治疗。

Objective: To summarize and analyze the clinical data and laboratory characteristics of Multiple Myeloma(MM), to enhance the understanding of the disease, and to reduce the rate of missed diagnosis and misdiagnosis. Methods: The clinical and laboratory data of 15 MM patients were analyzed retrospectively. Results: Among 15 cases, 13 were anaemia, 10 were renal insufficiency, 3 were bone pain and bone disease, 1 was lung infection, 1 was intracranial occupying, 1 was pancytopenia, 1 was ascending aorta dilation, most of which were anaemia, renal function impairment and fracture together with bone pain. Bone marrow cytology showed that the proportion of plasma cells was increased, and the morphology was diversified. X-ray examination showed multiple wormlike and chiseled bone destruction shadow, low density, clear or unclear boundary, and even pathological fracture.Conclusion: Multiple myeloma is more common in middle-aged and elderly people, and the incidence rate of aging is increasing year by year. Its clinical manifestations are complex and diverse, causing rare clinical symptoms such as anemia, infection, renal function damage, bone pain, pathological fracture, and even local tumor or space occupying, which are often misdiagnosed due to lack of specificity.In the practical work, the clinical staff should strengthen the understanding of MM, master the complex characteristics of its clinical manifestations, and make a comprehensive analysis of the abnormal laboratory examination results, so that MM can be diagnosed and treated in time.