多发性骨髓瘤肾损伤患者的临床特征分析  

Clinical characteristics of renal impairment in patients with multiple myeloma

作　　者：高琛妮 史浩[1] 李晓[1] 徐静[1] 潘晓霞[1] 任红[1] 张文[1] 谢静远[1] 陈伟红[1] 陈晓农[1] GAO Chenni;SHI Hao;LI Xiao;XU Jing;PAN Xiaoxia;REN Hong;ZHANG Wen;XIE Jingyuan;CHEN Weihong;CHEN Xiaonong(Department of Nephrology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏内科,上海200025

出　　处：《上海医学》2021年第9期671-675,共5页Shanghai Medical Journal

基　　金：上海市临床重点专科建设项目(shslczdzk02502);上海市青年科技英才扬帆计划(20YF1428400);上海市卫生健康委员会青年科研课题(20204Y0126);中关村肾病血液净化创新联盟青年研究基金(NBPIA20QC0302)。

摘　　要：目的分析多发性骨髓瘤(multiple myeloma,MM)肾损伤患者的临床特征,进一步提高对该疾病的诊治水平。方法回顾性分析2015年1月—2020年12月于上海交通大学医学院附属瑞金医院肾脏内科住院,首次诊断为MM肾损伤的患者,并依据改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)指南将患者分为急性肾损伤(acute kidney injury,AKI)组与非AKI组,比较两组患者的一般情况、实验室检查结果及病理学特征。采用Spearman相关性分析和logistic回归模型分析AKI发生的危险因素。结果本研究共纳入70例患者(其中男性39例、女性31例),年龄为(61.4±10.4)岁,34例(48.6%)患者合并AKI。非AKI患者中,CKD 3~5期占61.1%(22/36)。29例患者接受了肾穿刺活组织检查,其中13例(44.8%)有骨髓瘤管型肾病表现。60例(85.7%)患者选择以硼替佐米为主的化学治疗(简称化疗)方案,31例(44.3%)患者进行血液透析治疗;24例(34.3%)患者进行血浆置换治疗。与非AKI组相比,AKI组患者的年龄更大,血红蛋白水平更低,血尿素氮、血肌酐、血尿酸、胱抑素C、β2微球蛋白、乳酸脱氢酶水平更高,差异均有统计学意义(P值均<0.05)。Spearman相关性分析显示,血红蛋白水平与AKI发生呈负相关(r=-0.376,P<0.01);血尿素氮、血肌酐、血尿酸、胱抑素C、β2微球蛋白水平、骨髓瘤的国际分期体系(ISS)分期与AKI发生呈正相关(r=0.522、0.580、0.322、0.495、0.532、0.322,P值均<0.01)。logistic回归分析显示:初诊时血肌酐水平(OR=1.004,95%CI为1.002~1.007,P=0.001)是AKI发生的危险因素。结论MM肾损伤形式多样,AKI是其常见表现,肾脏病理学改变以管型肾病为主。需要同时兼顾原发病与受累肾脏的治疗。Objective To analyze clinical characteristics of renal impairment in patients with multiple myeloma(MM).Methods Patients admitted to our hospital due to MM combined with renal impairment from January 2015 to December 2020 were retrospectively analyzed.They were divided into acute kidney injury(AKI)group and non-AKI group according to KDIGO(Kidney Disease:Improving Global Outcomes)guideline.General information,laboratory examinations and pathological characteristics of the two groups were compared.Results Seventy patients were enrolled in this study.There were 39 males and 31 females with the age of(61.4±10.4)years old.AKI occurred in 34(48.6%)patients.In non-AKI group,CKD stage 3-5 accounted for 61.1%(22/36).Renal biopsy was performed in 29 patients,of whom 13(44.8%)revealed cast nephrotpathy.As for treatment,60(85.7%)patients were treated by bortezomib-based chemotherapy,31(44.3%)received hemodialysis and 24(34.3%)underwent plasma exchange.Compared with non-AKI group,patients in AKI group were older,had lower level of hemoglobin and higher levels of serum urea,creatinine,uric acid,cystain C,β2-microglobin and lactate dehydrogenase(all P<0.05).Spearman correlation analysis revealed that hemoglobin was negatively related to AKI(r=-0.376,P<0.01),while serum urea,creatinine,uric acid,cystain C,β2-microglobin and International staging system(ISS)stage were positively related to AKI(r=0.522,0.580,0.322,0.495,0.532,0.322,all P<0.01).Logistic analyses revealed that baseline serum creatinine(OR=1.004,95%CI:1.002-1.007,P=0.001)was a risk factor for AKI.Conclusion MM patients have various renal impairment,and AKI is a common form.The most common renal pathological manifestation is cast nephropathy.It is vital to treat both primary disease and the affected kidney.

关 键 词：多发性骨髓瘤 急性肾损伤 管型肾病 临床特征 

分 类 号：R733.3[医药卫生—肿瘤]