年轻骨髓瘤患者临床特点和生存分析  

Clinical features and survival of myeloma patients younger than 40 years.

作　　者：赵莹[1] 邹外一[1] 李娟[1] 黄蓓晖[1] 罗绍凯[1] 谷景立[1] 王清[1] 

机构地区：[1]中山大学附属第一医院血液科,广州510080

出　　处：《中国实用内科杂志》2008年第11期934-936,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨年轻骨髓瘤(<40岁)患者的临床表现、实验室检查特点、对化疗的反应及长期存活情况。方法回顾性分析中山大学附属第一医院2000年1月至2007年9月收治的<40岁(24例)和≥40岁(206例)骨髓瘤患者的临床资料,比较两组患者的临床表现、化疗疗效和存活情况等。结果230例骨髓瘤患者中,<40岁者24例,占10.4%。与中老年患者(≥40岁)相比,<40岁患者的骨髓瘤类型以IgG型为主(54.2%对45.1%),IgA型少见(4.2%对21.8%),孤立性或髓外骨髓瘤比例高(12.5%对1.9%)。年轻患者伴髓外浸润的比例明显高于中老年患者(23.8%对3.0%,P<0.01),血清β2-微球蛋白(β2-MG)较低(P=0.032),白蛋白低于正常的患者较少(P=0.023)。<40岁和≥40岁患者对化疗的部分缓解率(PR)(69.2%对55.6%,P=0.355)比较差异无统计学意义,中位总存活时间分别为39.6个月和29.3个月,前者存活期略长,但差异无统计学意义(P=0.280)。伴髓外浸润的年轻患者对化疗反应较差,存活期短。结论我国年轻骨髓瘤患者的比例高于国外,对于年轻患者尤其是伴有髓外浸润的多发性骨髓瘤患者,应尽早给予大剂量化疗和造血干细胞移植,以延长存活期。Objectlve To explore the clinical and laboratory features, chemotherapy responses and long-term survival of multiple myeloma in patients younger than 40 years. Methods The clinical data of 230 cases of newly diagnosed myeloma patients admitted to the First Affiliated Hospital of Sun Yat-sen University from Jan. 2000 to Sep. 2007 were analyzed retrospectively. Results There were 24（ 10. 4% ） of 230 patients younger than 40 when diagnosed. Compared with the patients older than 40, the main myeloma type of younger patients was also mainly IgG （54. 2% vs 45. 1% ）, but younger patients had fewer IgA type （4. 2% vs 21.8% ）, more solitary amt extramedullary myeloma （ 12. 5% vs 1.9% ）, P = 0. 009. The younger patients had higher extramedullary infiltration rate （ 23.8% vs 3.0% , P 〈 0. 001 ） , lower serum β2- MG level（ P = 0. 032 ） and fewer patients with albumin lower than normal level （ P = 0. 023 ）. The two groups had similar partial responsive rate （69. 2% vs 55.6% ,P = 0. 355 ）to chemotherapy. The patients younger than 40 had longer median overall survival than elder patients （39. 6 months vs 29. 3 months）, but there had no statistical difference（ P = 0. 280 ）. It seems that the younger patients with extramedullary infiltration had poor responses to chemotherapy and shorter survival. Conclusion The incidence of younger myeloma patients in China is higher than abroad. Younger patients should receive high dose chemotherapy followed by haemopoietic stem cell transplant as early as possible, especially those with extramedullary infiltration.

关 键 词：骨髓瘤 年轻病人 化疗 

分 类 号：R5[医药卫生—内科学]