MGUS、MM的临床病理特点的对比及MM伴肾功能不全的危险因素分析

发布时间：2018-07-07 23:40

本文选题：单克隆免疫球蛋白血症 + 多发性骨髓瘤　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨单克隆免疫球蛋白血症(monoclonal gammopathy of undeter mined significanees,MGUS)、多发性骨髓瘤(multiple myeloma,MM)患者的临床指标的差异,指导临床早期诊断;分析多发性骨髓瘤伴肾功能不全患者的危险因素,早期预防。方法:选择2012年—2016年在广西医科大学第一附属医院住院诊断为单克隆免疫球蛋白血症的患者14例,及多发性骨髓瘤的患者225例,比较两者的临床、病理特点;回顾性分析多发性骨髓瘤伴肾功能不全患者的危险因素和不同方案治疗后肾脏转归情况。结果:1.单克隆免疫球蛋白血症患者中男性占57.1%,多发性骨髓瘤男性占61.8%。单克隆免疫球蛋白血症、多发性骨髓瘤发病平均年龄分别是(54.5±6.79)岁、(60.84±9.34)岁。首发临床症状上,单克隆免疫球蛋白血症以贫血、骨痛、水肿多见(28.57%、21.43%、21.43%),多发性骨髓瘤以骨痛最多见(59.11%),其次为贫血症状(16.89%)。2.两组疾病患者尿蛋白阳性率、尿潜血阳性率无差异;单克隆免疫球蛋白血症患者中24小时尿液蛋白定量中位数为362.95mg/24h,多发性骨髓瘤为1068.2mg/24h,P=0.017,差异有统计学意义。3.单克隆免疫球蛋白血症患者平均血色素为101.7(80.8-117.2)g/L,血肌酐为74.0(57.8-115.5)μmol/L,骨髓浆细胞含量为2.5(0.5-6.0)%,原幼浆细胞比例为0(0-5.5)%,行骨骼影像检查的5例患者均无骨质疏松、骨质破坏表现;多发性骨髓瘤患者平均血色素为76.7(65.2-90.4)g/L,血肌酐为97.0(75.5-222)μmol/L,浆细胞含量为31.25(16.5-50.0)%,原幼浆细胞比例为27.3(13.0-45.9)%,有107例(52%)符合骨髓瘤骨质疏松伴破坏特点。以上指标均具有统计学意义。4.有2例单克隆免疫球蛋白血症患者行肾脏穿刺病理活检术,病理类型分别是轻微病变性肾小球肾炎、膜性肾病;有5例多发性骨髓瘤患者行肾脏穿刺病理活检术,其中有3例病理类型是轻微病变性肾小球肾炎伴不同程度肾小管间质损伤,1例为局灶节段性肾小球硬化症伴小管间质重度损伤,1例为淀粉样变性肾病。5.定期随访的6例单克隆免疫球蛋白血症患者,4例规律化疗的患者在末次随访时肾功能稳定,2例未化疗患者末次随访时肾功能较初诊进展。6.二分类非条件Logistic回归分析示男性、血红蛋白、血清钙、原幼浆细胞比例、轻链类型均是多发性骨髓瘤肾病的独立危险因素。7.治疗多发性骨髓瘤伴肾功能不全的两组方案(含硼替佐米方案、传统方案)对肾功能恢复率比较无差异。结论:1.单克隆免疫球蛋白血症患者起病年龄较多发性骨髓瘤患者年轻。2.多发性骨髓瘤患者贫血较单克隆免疫球蛋白血症患者严重。3.多发性骨髓瘤患者的血肌酐值较单克隆免疫球蛋白血症高,内生肌酐清除率较低。4.男性、贫血、血清钙、原幼浆细胞比例、轻链类型均是多发性骨髓瘤合并肾功能不全的危险因素。
[Abstract]:Objective: to investigate the difference of clinical indexes in patients with monoclonal immunoglobulinemia (monoclonal gammopathy of undeter mined significant aneus) and multiple myeloma (multiple myeloma), to guide the early diagnosis of multiple myeloma and to analyze the risk factors and early prevention of multiple myeloma with renal insufficiency. Methods: 14 patients with monoclonal immunoglobulinemia and 225 patients with multiple myeloma were selected from the first affiliated Hospital of Guangxi Medical University from 2012 to 2016. The clinical and pathological features were compared. The risk factors and renal outcomes of multiple myeloma patients with renal insufficiency were analyzed retrospectively. The result is 1: 1. The percentage of male patients with monoclonal immunoglobulinemia was 57.1 and that with multiple myeloma was 61.8. The mean age of multiple myeloma was (54.5 卤6.79) years old and (60.84 卤9.34) years old respectively. The first clinical symptoms were anemia, bone pain, edema (28.57%), bone pain (59.11%), anemia (16.89%) .2. There was no difference in the positive rate of urinary protein and occult blood between the two groups, the median of 24 hours urine protein in patients with monoclonal immunoglobulinemia was 362.95 mg / 24 h, and that in multiple myeloma was 1068.2 mg / 24 h, the difference was statistically significant. The mean hemoglobin level was 101.7 (80.8-117.2) g / L, serum creatinine was 74.0 (57.8-115.5) 渭 mol / L, bone marrow plasmacyte content was 2.5 (0.5-6.0), and the ratio of protoplasmic cells was 0 (0-5.5). The mean hemoglobin was 76.7 (65.2-90.4) g / L, serum creatinine was 97.0 (75.5-222) 渭 mol / L, plasma cell content was 31.25 (16.5-50.0), plasma cell ratio was 27.3 (13.0-45.9) in patients with multiple myeloma, 107 cases (52%) were in accordance with the characteristics of osteoporosis associated with destruction of myeloma. The above indexes have statistical significance. Two patients with monoclonal immunoglobulinemia underwent renal biopsy, the pathological types were mild pathological glomerulonephritis and membranous nephropathy, and 5 patients with multiple myeloma underwent renal biopsy. Among them, 3 cases were mild pathological glomerulonephritis with different degree of renal tubulointerstitial injury. One case was focal segmental glomerulosclerosis with tubulointerstitial severe injury and one case was amyloidosis nephropathy. The renal function of 6 patients with monoclonal immunoglobulinemia and 4 patients with regular chemotherapy were stable at the last follow-up. The renal function of 2 patients without chemotherapy at the last follow-up was more advanced than that of the first visit. Non-conditional logistic regression analysis showed that male, hemoglobin, serum calcium, ratio of plasma cells and light chain type were all independent risk factors of multiple myeloma nephropathy. There was no difference in the recovery rate of renal function between the two groups (including boron tezomil regimen, traditional regimen) in the treatment of multiple myeloma with renal insufficiency. Conclusion 1. The onset age of patients with monoclonal immunoglobulinemia was younger than that of patients with multiple myeloma. Anemia in patients with multiple myeloma was more severe than that in patients with monoclonal immunoglobulinemia. The serum creatinine level of multiple myeloma patients was higher than that of monoclonal immunoglobulinemia, and the clearance rate of endogenous creatinine was lower than that of monoclonal immunoglobulinemia. Men, anemia, serum calcium, ratio of plasma cells, light chain type were risk factors of multiple myeloma complicated with renal insufficiency.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.3;R55

【参考文献】