多发性骨髓瘤合并肾损伤患者临床特征及肾损伤危险因素分析

Analysis of clinical characteristics of multiple myeloma patients combined with kidney injury and risk factors for kidney injury

目的探讨多发性骨髓瘤(MM)合并肾损伤患者的临床特征及发生肾损伤的相关危险因素。方法回顾性分析2017年1月至2021年6月菏泽市立医院收治的96例初治MM患者临床资料,以确诊时血肌酐是否>177μmol/L,分为肾损伤组33例和非肾损伤组63例。比较两组患者的一般资料和实验室检查结果。采用logistic回归法分析MM患者肾损伤的危险因素,绘制受试者工作特征(ROC)曲线,评估各危险因素对MM患者发生肾损伤的预测价值。结果肾损伤组血红蛋白低于非肾损伤组,白细胞计数、血尿酸、尿素氮、β2-微球蛋白(β2-MG)、胱抑素C及轻链型患者比例、国际分期系统(ISS)-Ⅲ期患者比例均高于非肾损伤组,差异均有统计学意义(均P<0.05)。34例行荧光原位杂交(FISH)检测,22例(64.7%)结果异常。非肾损伤组26例行基因检测,结果异常14例,其中IgH重排11例(42.3%),RB1缺失4例(15.4%),1q21扩增4例(15.4%),P53缺失1例(3.8%);肾损伤组8例行基因检测,结果均异常,其中IgH重排6例(75.0%),RB1缺失5例(40.0%),1q21扩增例2例(25.0%),P53缺失1例(12.5%);肾损伤组RB1突变率高于非肾损伤组,差异有统计学意义(χ^(2)=4.43,P=0.035)。logistic回归分析显示血尿酸升高(OR=1.009,95%CI 1.002~1.016,P=0.015)、ISS-Ⅲ期(OR=16.401,95%CI 1.174~229.164,P=0.038)、白细胞计数升高(OR=1.833,95%CI 1.020~3.294,P=0.043)、β2-MG升高(OR=1.320,95%CI 1.009~1.728,P=0.043)、血红蛋白降低(OR=0.900,95%CI 0.832~0.922,P=0.008)是MM患者发生肾损伤的独立危险因素。根据ROC曲线下面积(AUC),血尿酸(AUC=0.775,95%CI 0.675~0.875,P<0.001)、白细胞计数(AUC=0.696,95%CI 0.583~0.809,P=0.002)、β2-MG(AUC=0.822,95%CI 0.732~0.911,P<0.001)、血红蛋白(AUC=0.755,95%CI 0.652~0.857,P<0.001)、ISS-Ⅲ期(AUC=0.763,95%CI 0.669~0.856,P<0.001)对MM肾损伤均具有预测价值。结论MM患者合并肾损伤发生率高,积极监测和控制危险因素可提高疗效,改善患者预后。

Objective To investigate the clinical characteristics of patients with multiple myeloma(MM)combined with kidney injury and the risk factors associated with the occurrence of kidney injury.Methods The clinical data of 96 newly treated MM patients in Heze Municipal Hospital from January 2017 to June 2021 were retrospectively analyzed,and the patients were divided into the kidney injury group(33 cases)and the non-kidney injury group(63 cases)based on whether the blood creatinine was>177μmol/L at the time of diagnosis.The general data and laboratory results of the two groups were compared.The risk factors for kidney injury in MM patients were analyzed by logistic regression method,and the receiver operating characteristic(ROC)curve was drawn to assess the predictive value of each risk factor for the occurrence of kidney injury in MM patients.Results Compared with the non-kidney injury group,hemoglobin was lower in the kidney injury group,and white blood cell count,blood uric acid,urea nitrogen,β2-microglobulin(β2-MG),cystatin C,the proportion of patients with light chain type,and the proportion of patients with international staging system(ISS)stageⅢwere higher in the kidney injury group,and the differences were statistically significant(all P<0.05).Thirty-four patients underwent fluorescence in situ hybridization(FISH)test,and 22 cases(64.7%)had abnormal results.In the non-kidney injury group,genetic testing were performed in 26 cases,and the results were abnormal in 14 cases,including 11 cases(42.3%)of IgH rearrangement,4 cases(15.4%)of RB1 deletion,4 cases(15.4%)of 1q21 amplification,and 1 case(3.8%)of P53 deletion;in the kidney injury group,8 cases underwent genetic testing,and all results were abnormal,including 6 cases(75.0%)of IgH rearrangement,5 cases(40.0%)of RB1 deletion,and 2 cases(25.0%)of 1q21 amplification.The rate of RB1 mutation in the kidney injury group was higher than that in the non-kidney injury group,and the difference was statistically significant(χ^(2)=4.43,P=0.035).Logistic regression analysis showed that elevated blood uric acid(OR=1.009,95%CI 1.002-1.016,P=0.015)and ISS stageⅢ(OR=16.401,95%CI 1.174-229.164,P=0.038),elevated white blood cell count(OR=1.833,95%CI 1.020-3.294,P=0.043),elevatedβ2-MG(OR=1.320,95%CI 1.009-1.728,P=0.043),and decreased hemoglobin(OR=0.900,95%CI 0.832-0.922,P=0.008)were independent risk factors for the development of kidney injury in MM patients.According to the area under the ROC curve(AUC),blood uric acid(AUC=0.775,95%CI 0.675-0.875,P<0.001),white blood cell count(AUC=0.696,95%CI 0.583-0.809,P=0.002),β2-MG(AUC=0.822,95%CI 0.732-0.911,P<0.001),hemoglobin(AUC=0.755,95%CI 0.652-0.857,P<0.001),and ISS stageⅢ(AUC=0.763,95%CI 0.669-0.856,P<0.001)had predictive value for kidney injury in MM.Conclusions MM patients have a high incidence of combined kidney injury,and active monitoring and control of risk factors may improve the outcome and prognosis of patients.