多发性骨髓瘤82例临床与实验室分析

Clinical and Laboratory Analysis of 82 Patients with Multiple Myeloma

目的:研究多发性骨髓瘤(MM)的临床及实验室特征。方法:回顾性分析82例初诊MM患者的临床、实验室及其他相关辅助检查资料。结果:A亚型和B亚型中,单独或合并存在B-J蛋白尿者各占20％和51.9％;Ⅲ期患者各占67.3％和92.6％;β_2微球蛋白(β_2-MG)≥6mg/L者各占43.8％和87.5％;血钙≥2.98 mmol/L者各占5.5％和25.9％,以上4项指标两组间均有统计学差异(P<0.01,P<0.05,P<0.01和P<0.025)。血红蛋白(Hb)<85g/L在原始型+不成熟型组和中间型+成熟型组各占82.4％和40％;β_2-MG≥6mg/L在两组各占87.5％和20.0％;骨髓浆细胞百分数≥30％在两组各占76.5％和32.0％,以上3项指标两组间差异均有显著性(P<0.025,P<0.005和 P<0.025);缓解、进步与无效3组年龄>65岁者各占30％、32.6％与37.5％,无统计学差异(P>0.05)。结论:MM常以骨、肾损害为首发表现;IgA比IgG型患者更易出现高黏滞综合征;病程早期血小板减少很少见;高钙血症发生率低;肾功能损害多见于B-J蛋白尿、Ⅲ期和高钙患者,常伴有β_2-MG增高,原始型和不成熟型患者多伴低Hb、高β_2-MG和高骨髓浆细胞比例。

Objective: To explore the clinical and laboratory features of multiple myeloma(MM) . Methods: Clinical and labortory data of 82 previously untreated patients with MM were analyzed. Results: In MM subgroup A and B, patients with Bence Jones pro-teinuria were 20% and 51. 9% , respectively( P < 0. 01), patients of stage El were 67. 3% and 92. 6% , respectively( P < 0. 05), patients with serum p2-MG5>6 mg/L were 43. 8% and 87. 5%, respectively(P < 0. 01), and patients with serum Ca>2. 98 mmol/L were 5. 5% and 25. 9%, respectively( P < 0. 025). In the groups of combinding plasmablast with immature plasmacyte and combinding intermediate with mature plasmacyte, patients with Hb level < 85g/L were 82. 4% and 40% respectively( P < 0. 025), patients with serum p2-MG 6 mg/L were 87. 5% and 20% respectively( P < 0. 005), and patients with^30% bone marrow plasma-cell (BMPC) were 76. 5% and 32. 0% respectively( P < 0. 025) . Elder patients( > 65 years) among the groups of complete or partial response, improvement and disease progression were 30% , 32. 6% and 37. 5% respectively! P > 0. 05). Conclusion: Patients with IgA myeloma have hyperviscosity more usually than patients with IgG myeloma. Thrombocytopenia is rare in early phase of myeloma; The incidence of hypercalcemia was low. Renal insufficiency was more common in patients with Bence Jones proteinuria, stage HI, hypercalcemia and increased serumb2-MG. Lower Hb, higher b2-MG level and higher BMPC were more common in the group of combingding plasmablast with immature plasmacyte.