38例多发性骨髓瘤肾损害临床分析  

Clinical analysis of 38 multiple myeloma patients with renal involvement

作　　者：黄淑环[1] 蔡成才[1] 陈烜[1] 梁卓林[1] 

机构地区：[1]广东省肇庆市第一人民医院,526021

出　　处：《广州医药》2005年第2期50-52,共3页Guangzhou Medical Journal

摘　　要：目的探讨多发性骨髓瘤肾损害患者的临床表现、诊断及其治疗效果。方法对10年间确诊的38例多发性骨髓瘤肾损害患者的临床资料进行回顾性分析。结果38例患者均有不同程度的贫血(血红蛋白41～90g/L),尿蛋白(+～+++),肾衰竭(血清肌酐442～1021μmol/L);10例(26.3%)血尿酸增高;5例(13.2%)血钙升高。除2例放弃治疗外,36例经综合治疗后29例(76.3%)完全缓解。结论多发性骨髓瘤肾损害临床表现复杂,对蛋白尿、肾衰竭病人应首先考虑该病的可能,并进行骨髓穿刺或活检术、血清蛋白电泳血清免疫球蛋白和尿本周氏蛋白等检查,才不致于漏诊、误诊。一旦明确诊断,积极输液,利尿,促进尿酸排泄,应用血液透析和化学治疗等,可改善预后。Objective To explore the clinical characteristics, diagnosis and therapeutic efficacy in 38 newly diagnosed multiple myeloma(MM) patients with renal involvement. Methods Clinical features of 38 MM patients with renal involvement in our hospital between 1994 and 2003 were studied retrospectively. Results Anemia(hemoglobin 41～90 g/L), proteinuria(+～+++)and renal failure(serum creatinine 442～1021 μmol/L)were found in all 38 patients; Levels of plasma uric acid was increased in 10 patients(26.3%); 5 patients(13.2%) were proven to have hypercalcemia. Except 2 cases giving up treatment, 36 patients received general treatment and 29 patients(76.3%) were complete remission. Conclusion Clinical manifestation of MM is complex. Patients with proteinuria and renal failure should be thought to have MM. Bone marrow puncture or biopsy must be done and serum protein electrophoresis, serum immunoglobulin, Bence-Jones protein in urine must be mearsured to avoid missed diagnosis or misdiagnosis. When diagnosis is clear, active transfusion, diuresis, promoting uric acid excretion, hemodialysis and chemical therapy can improve prognosis.

关 键 词：多发性骨髓瘤 肾损害 临床分析 血清免疫球蛋白 本-周氏蛋白 血清蛋白电泳 临床表现 回顾性分析 血尿酸增高 治疗效果 临床资料 10年间 血红蛋白 不同程度 血清肌酐 放弃治疗 完全缓解 衰竭病人 化学治疗 血液透析 改善预后 

分 类 号：R733.3[医药卫生—肿瘤] R544.1[医药卫生—临床医学]