多发性骨髓瘤患者的心脏损害特征分析

Clinical and cardiac damage characteristics in patients with multiple myeloma

目的多发性骨髓瘤(MM)多合并心脏损害,MM合并心脏损害的早期特征少有报道,通过回顾分析140例MM患者的临床首诊资料,为MM合并心脏损害的早期诊断和治疗提供依据。方法收集2012年1月至2022年1月于甘肃省人民医院确诊为MM的患者140例,回顾分析其首诊临床资料、实验室检查及心电图资料。结果年龄是发生MM的独立危险因素。早期有55%的患者心肌肌钙蛋白T(cTnT)≥14 ng/L。cTnT升高组(≥14 ng/L)男性占70.1%,显著高于正常组(<14 ng/L,49.2%),差异有统计学意义(P<0.05)。cTnT升高组年龄≥60岁占64.9%,显著高于正常组(47.6%),差异有统计学意义(P<0.05)。cTnT升高组血肌酐>177μmol/L占42.9%,显著高于正常组(7.9%),差异有统计学意义(P<0.001)。cTnT升高组国际分期系统(ISS)分期Ⅲ期占62.3%,显著高于正常组(27.0%),差异有统计学意义(P<0.001)。cTnT升高组心电图异常占87.0%,显著高于正常组(50.8%),差异有统计学意义(P<0.001)。cTnT水平与年龄(OR=1.047,95%CI:1.002~1.095,P<0.05)、血肌酐(OR=1.008,95%CI:1.002~1.013,P<0.01)、心电图(OR=6.491,95%CI:2.836~14.854,P<0.001)有显著相关性,年龄、血肌酐、心电图异常是cTnT升高的危险性因素。结论大多数MM患者早期合并心脏损害,与性别、年龄、血肌酐水平、ISS分期、心电图是否正常有关。

Objective To analyze retrospectively the first-time clinical materials from 140 patients with multiple myeloma(MM)and provide the basis for early diagnosis and treatment of MM complicated by cardiac damage.Methods MM patients(n=140)were chosen from People’s Hospital of Gansu Province from Jan.2012 to Jan.2022,and their first-time clinical materials,results of laboratory examinations and data of electrocardiogram(ECG)were analyzed retrospectively.Results Age was a independent risk factor of MM occurrence.In the early stage,cardiac troponin T(cTnT)≥14 ng/L was found in 55%of patients.In high-cTnT group(≥14 ng/L),male cases accounted for 70.1%,which was significantly higher than that in normal group(cTnT<14 ng/L,49.2%,P<0.05).The patients aged≥60 accounted for 64.9%in high-cTnT group and 47.6%in normal group(P<0.05).The patients with serum creatinine(SCr)>177μmol/L accounted for 42.9%in high-cTnT group and 7.9%in normal group(P<0.001).The patients with stage III of international staging system(ISS)accounted for 62.3%in high-cTnT group and 27.0%in normal group(P<0.001).The patients with abnormal ECG accounted for 87.0%in high-cTnT group and 50.8%in normal group(P<0.001).The level of cTnT was significantly correlated to age(OR=1.047,95%CI:1.002~1.095,P<0.05),SCr(OR=1.008,95%CI:1.002~1.013,P<0.01)and ECG(OR=6.491,95%CI:2.836~14.854,P<0.001).Age,SCr and abnormal ECG were risk factors of cTnT increase.Conclusion Most MM patients are complicated by cardiac damage in the early stage,which is related to gender,age,SCr level,ISS stage and abnormal ECG.