以长期腰背痛和自发骨折为表现的老年不分泌型多发性骨髓瘤一例  

Atypical senile nonsecretory multiple myeloma with long-term back pain and spontaneous fracture:one case report

作　　者：宋謌 杨波[2,3] 楼方定 阎丽 周长喜 吴璇[1,2] 蔡力力 朱平[1,2] 卢学春 SONG Ge;YANG Bo;LOU Fang-Ding;YAN Li;ZHOU Chang-Xi;WU Xuan;CAI Li-Li;ZHU Ping;LU Xue-Chun(Department of Geriatrics,Second Medical Center,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;National Clinical Research Center for Geriatric Diseases,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Hema-tology,Second Medical Center,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Hematology,First Medical Center,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Laboratory Medicine,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第二医学中心老年医学科,北京100853 [2]中国人民解放军总医院国家老年疾病临床医学研究中心,北京100853 [3]中国人民解放军总医院第二医学中心血液科,北京100853 [4]中国人民解放军总医院第一医学中心血液科,北京100853 [5]中国人民解放军总医院第二医学中心检验科,北京100853

出　　处：《中华老年多器官疾病杂志》2022年第2期135-139,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：军队保健专项课题(19BJZ28);军队重点保健专项课题(18BJZ32);国家重点研发计划(2019YFC2002706)。

摘　　要：本文报道一例以长期持续腰背部疼痛及多发骨折就诊的72岁老年不典型多发性骨髓瘤患者。患者因腰背痛曾就诊于多家医院,病程约17个月,多次行CT、MRI及实验室检查,提示存在多发骨破坏,考虑重度骨质疏松。针对腰椎压缩性骨折,行腰2/4椎体骨折球囊撑开椎体后凸成形术及腰2椎体活检术,病理未发现肿瘤细胞。由于腰背痛持续加重,患者入住中国人民解放军总医院第二医学中心。综合评估,患者存在严重消瘦(恶液质状态)、纳差、卧床状态、全身多处疼痛、无法站立及行走、贫血、高钙血症、多发骨破坏,无M蛋白血症,考虑多发性骨髓瘤、肿瘤(如肺癌、前列腺癌、类癌等)骨转移、组织细胞增生症X及重度骨质疏松症等诊断。但经髂骨穿刺及活检、基于PET/CT肋骨破坏部位的CT引导下穿刺活检,均未发现肿瘤细胞(包括具有诊断意义的异常浆细胞显著增生)。最后,经胸骨穿刺确诊为多发性骨髓瘤。随后,患者接受了连续6个周期的硼替佐米联合地塞米松(简称PD或BD)方案和2个周期的硼替佐米、地塞米松联合多柔比星脂质体(简称PAD)方案治疗,并每2个周期进行一次疗效评估,评估结果均为部分缓解(VGPR)。患者目前恢复为患病前的生活自理状态。A 72-year-old atypical-multiple-myeloma patient,who visited the hospital for long-term persistent back pain and multiple fractures was reported.The patient had undergone treatment in several hospitals for back pain,with about 17 months of disease course.Several CT,MRI,and laboratory tests had been performed.The results showed that there was multiple bone destruction,and severe osteoporosis was considered.Lumbar 2nd/4th vertebral-body-fracture balloon kyphoplasty and lumbar 2nd vertebral-body biopsy were performed to treat the patient′s lumbar vertebral compression fractures.No tumor cells were found by the pathology examination.The patient was hospitalized in the Second Medical Center of Chinese PLA General Hospital for the persistently-aggravated back pain.According to the comprehensive evaluation,the patient had severe emaciation(cachexia state),anorexia,bedridden state,multiple pain,inability to stand and walk,anemia,hypercalcemia,multiple bone destruction,and no M-proteinemia.The results were considered as multiple myeloma,tumor′s bone metastasis(such as lung cancer,prostate cancer,carcinoid,etc.),histiocytosis X and severe osteoporosis.However,no tumor cells(including notable diagnostically-significant abnormal-plasma-cell proliferation)were found in both the trans-iliac puncture&biopsy and PET/CT-based rib-damaged-site CT-guided puncture&biopsy.Finally,multiple myeloma was definitely diagnosed by trans-sternal puncture.The patient then received the 6-consecutive-course of bortezomib combined with dexamethasone(PD or BD regimen)and 2-course of bortezomib and dexamethasone combined with doxorubicin liposome(PAD regimen).Furthermore,a therapeutic evaluation was performed every two courses.It showed the disease had got partially remitted(VGPR).Currently,the patient recovers to the self-care state before the illness.

关 键 词：老年人 多发性骨髓瘤 骨质疏松 诊断 

分 类 号：R733.3[医药卫生—肿瘤]