老年人意义未明单克隆免疫球蛋白血症转归为多发性骨髓瘤的临床特征分析  

Clinical features analysis of monoclonal immunoglobulinemia of undetermined significance transforming into multiple myeloma in the elderly

作　　者：王海飞[1] 刘辉[1] 魏建平[1] 

机构地区：[1]北京医院血液内科,100730

出　　处：《中华老年医学杂志》2015年第6期651-653,共3页Chinese Journal of Geriatrics

摘　　要：目的 了解由意义未明单克隆免疫球蛋白血症（MGUS）转归为多发性骨髓瘤（MM）的时间,免疫球蛋白水平变化及临床特征. 方法 回顾性分析我院22例MM患者,根据免疫球蛋白的随访情况分正规随诊组和非正规随诊组,了解免疫球蛋白浓度、血钙、血红蛋白、肌酐变化及转归为MM的时间,评估治疗对患者预后的影响. 结果 正规随诊组诊断MGUS时的中位年龄为69岁,转归为MM中位时间为9.8年;非正规随诊组诊断为MGUS时的中位年龄为79岁,转归为MM中位时间为1.3年,两组转归为MM时间差异有统计学意义（P=0.006）.非正规随诊组发现MGUS患者初始免疫球蛋白浓度均值为12.5 g/L（2.0～31.6 g/L）,正规随诊组为11.5 g/L（2.8～29.0g/L）,差异无统计学意义（P＞0.05）.两组血钙、血红蛋白、肌酐指标在转归前后差异无统计学意义.治疗和非治疗组转归为MM的时间分别为9.8年和9.7年,生存时间分别为13.6年和13.5年,均差异无统计学意义. 结论 定期正规随诊能准确判定MGUS转归为MM的时间,其转归时间明显长于非正规随诊组;免疫球蛋白浓度、血钙、血红蛋白、血肌酐变化不能作为评价转归的指标;对MGUS药物治疗不能有效延缓MGUS向MM的进展时间,不能减少MM并发症及延长患者生存期.Objective To study the time of monoclonal immunoglobulinemia of undetermined significance （MIUS） transforming into multiple myeloma （MM）,and the changes of immunoglobulin level and the clinical features.Methods A retrospective analysis was conducted in 22 patients with MM.According to the follow-up of immunoglobulin levels,patients were divided into formal and informal groups.The changes in immunoglobulin,serum calcium,hemoglobin and creatinine concentrations,and the time of MIUS transforming into MM were detected,and the impact of treatment on the prognosis was analyzed.Results The median age at diagnosis as MIUS was 69 years in formal group and 79 years in informal group.The median time for MIUS transforming into MM was 9.8 years in formal group and 1.3 years in informal group （P 0.006）.The initial average concentration of immunoglobulin in patients with MIUS was 12.5 g/L （2.0-31.6 g/L） in informal group and 11.5 g/L （2.8-29.0 g/ L） in formal group （P〉0.05）.There were no significant differences in levels changes of immunoglobulin,serum calcium,hemoglobin,creatinine index before and after the outcome.The transfer time for MIUS transforming into multiple myeloma was 9.8 years and 9.7 years,and the survival time was 13.6 years and 13.5 years in patients with versus without treatment （P〉 0.05）.Conclusions Regular formal follow up can accurately assess the transfer time for MIUS to MM,and the transfer time is longer in formal groups than in informal group.The changes in concentrations of immune globulin,serum calcium,hemoglobin,and creatinine cannot serve as indicators for outcome evaluation.Drug treatment neither delays the progress time of MIUS to MM nor reduces the complications of MM and nor prolongs the survival time.

关 键 词：高丙种球蛋白血症 多发性骨髓瘤 

分 类 号：R733.3[医药卫生—肿瘤]