多发性骨髓瘤骨病外科手术治疗效果及预后影响因素分析

Analysis of Surgical Effect and Prognostic Influencing Factors of Multiple Myeloma

目的探讨多发性骨髓瘤(MM)骨病外科手术治疗效果及预后影响因素。方法回顾性分析行外科手术治疗的MM骨病患者96例临床资料,分析MM骨病外科手术治疗效果(疼痛程度、生活质量、体力状况和脊柱功能损伤情况)及预后影响因素。结果术后视觉模拟评分法(VAS)评分、Kamofsky评分、美国东部肿瘤协作组体力状况(ECOG)评分、Frankal评分均低于术前,差异有统计学意义(P<0.05);截止至末次随访时,96例患者中死亡20例(20.83%),生存76例(79.17%);单因素分析显示:乳酸脱氛酶(LDH)、C反应蛋白(CRP)、β_(2)-微球蛋白(β_(2)-MG)、MM细胞类型与MM骨病预后有关,差异有统计学意义(P<0.05);性别、年龄、手术部位、低蛋白血症、术前Frankal评分、脊柱病变数量、术前有无放疗、手术方式、ECOG评分、Durie-Salmon(DS)分期、血肌酐与MM骨病预后无关,差异无统计学意义(P>0.05);多因素分析显示:LDH≥240 U/L、CRP≥5 mg/L、β_(2)-MG≥3.5 mg/L、瘤细胞呈幼稚浆细胞型是影响MM骨病预后的高危因素(P<0.05)。结论外科手术能够改善MM骨病患者疼痛程度,减轻脊柱功能损伤,提高患者体力与生活质量,而LDH、CRP、β_(2)-MG、MM细胞类型是影响手术预后的重要因素,临床需加以重视。

Objective To investigate the surgical effect and prognosis factors of multiple myeloma(MM)bone disease.Methods 96 patients with MM bone disease were analyzed,Analysis of the treatment effect of MM bone disease surgery(pain degree,quality of life,physical condition and spinal function injury)and the prognostic influencing factors were conducted.ResultsPostoperative visual simulation scoring(VAS)score,Kamofsky score,physical status(ECOG)score,Frankal score were all lower than preoperative,there had statistically significant difference(P<0.05);Until the last follow-up,20 of the 96 patients died(20.83%),survival 76 cases(79.17%);Single factor analysis showed that LDH,CRP,β_(2)-MG,MM cell types were associated with the prognosis of MM bone disease,there had statistically significant difference(P<0.05);Gender,Age,surgical site,hypo protein emia,preoperative Frankal score,number of spinal lesions,preoperative radiotherapy,surgical method,ECOG score,Durie-Salmon(DS)staging,blood creatinine were not related of the prognosis of MM bone disease,there had non statistically significant difference(P>0.05);Multi-factor analysis showed that LDH≥240U/L、CRP≥5mg/L、β_(2)-MG≥3.5mg/L and tumor cells were high risk factor affecting the prognosis of MM bone disease(P<0.05).Conclusion Surgical operation can improve the pain degree,reduce the spinal function injury and improve the physical strength and quality of life of patients with MM osteopathy.LDH、CRP、β_(2)-MG、MM cell type are important factors affecting the prognosis of surgery.