多发性骨髓瘤骨病的临床病理特征及危险因素分析  

Clinicopathological features and risk factors of multiple myeloma bone disease

作　　者：陈冰融 舒文秀[1] 陈兵华[2] 乐静[1] CHEN Bingrong;SHU Wenxiu;CHEN Binghua;LE Jing(Department of Hematology,Ningbo Medical Center Lihuili Hospital,Ningbo 315040,China;不详)

机构地区：[1]宁波市医疗中心李惠利医院血液科,315040 [2]宁波市医疗中心李惠利医院检验科,315040

出　　处：《浙江医学》2022年第23期2521-2525,共5页Zhejiang Medical Journal

摘　　要：目的探讨初诊分泌型多发性骨髓瘤(MM)患者发生多发性骨髓瘤骨病(MMBD)的临床病理特征及相关危险因素。方法选取2015年1月-2020年12月宁波市医疗中心李惠利医院血液科222例初诊分泌型MM患者为研究对象,根据MMBD分级分为A组(MMBD 0~2级,102例)和B组(MMBD 3~4级,120例),分析两组患者的骨病特点、分级及临床病理资料,探讨临床病理特点对MMBD分级的影响。结果222例患者首诊骨痛发生率63.06%,高钙血症发生率9.45%,弥漫性骨质疏松症发生率75.22%,溶骨性破坏发生率69.81%;病理性骨折发生率34.68%。溶骨性破坏发生部位以脊柱、骨盆最多见;病理性骨折发生部位以脊柱、肋骨最多见。相比B组,A组BMI、Hb、外周血血小板绝对值、血清白蛋白、TG更高,年龄、血清磷、血清CPR、血清球蛋白、β2-微球蛋白、骨髓原始+幼稚浆细胞比例、骨髓浆细胞比例更低,差异均有统计学意义(均P<0.05)。多因素分析提示国际分期系统(ISS)分期、年龄、血清CPR、血清白蛋白、血清球蛋白是影响初诊分泌型MM患者发生3~4级MMBD的独立危险因素(均P<0.05)。结论MMBD是MM的常见并发症,多表现为骨量减少、溶骨性破坏改变;3~4级MMBD以老年、血清CPR及血清球蛋白升高者多见。Objective To analyze the clinicopathological features and related risk factors of multiple myeloma bone disease(MMBD)in patients with newly diagnosed multiple myeloma(MM).Methods A total of 222 newly diagnosed MM patients who were hospitalized between January 2015 and December 2020 in the Ningbo Medical Center Lihuili Hospital were enrolled.Based on their bone disease grading,patients were divided into group A(grades 0-2,n=102)and group B(grades3-4,n=120).The clinical data and laboratory findings were compared between two groups,and the risk factors related to MMBD were analyzed.Results In this series of MM patients,the incidence of bone pain,hypercalcemia,diffuse osteoporosiswas,osteolytic destruction,pathological fracture was 63.06%,9.45%,75.22%,69.81%,and 34.68%at the time of the first diagnosis,respectively.The spine and pelvis,and the spine and ribs were the most common sites for osteolytic fractures and pathological fractures,respectively.Compared to group A,patients in group B had lower body mass index,hemoglobin,absolute peripheral blood platelet,serum albumin,and serum total cholesterol values;while they had higher age,higher serum phosphorus,CRP,globulin andβ2 microglobulin levels,higher bone marrow plasma cell percentage and immature plasma cell percentage(all P<0.05).The logistic regression analysis showed that the absolute values of ISS stage,age,serum albumin,and serum globulin were independent risk factors for MMBD grades 3-4 in the newly diagnosed MM patients(P<0.05).Conclusion MMBD is a common complication of MM,and it mostly manifests as osteopenia and osteolytic destruction.MMBD grades 3-4 are more common in patients of advanced age with elevated serum CRP,and elevated serum globulin.

关 键 词：多发性骨髓瘤 骨髓瘤骨病 临床研究 

分 类 号：R733.3[医药卫生—肿瘤]