初诊多发性骨髓瘤合并胸腔积液临床特征及预后分析  

Characteristics and prognostic value of pleural effusion in newly diagnosed multiple myeloma

作　　者：王丽霞[1] 雷芳[1] 季艳萍 余先球[1] 陆雯萍 严琦[1] 张硕[1] 费小明[1] WANG Lixia;LEI Fang;JI Yanping;YU Xianqiu;LU Wenping;YAN Qi;ZHANG Shuo;FEI Xiaoming(Department of Hematology,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu,212001,China)

机构地区：[1]江苏大学附属医院血液科,江苏镇江212001

出　　处：《淮海医药》2023年第3期249-252,共4页Journal of Huaihai Medicine

基　　金：江苏省社会发展重点项目(临床前沿技术)(BE2020681);江苏大学附属医院科技项目(jdfyRC2019006)。

摘　　要：目的:研究初诊多发性骨髓瘤(MM)患者胸腔积液的发病情况、危险因素及其预后意义。方法:选取2011年1月—2022年1月江苏大学附属医院血液科初诊多发性骨髓瘤患者169例,根据患者在初诊时或第一个治疗周期内是否合并胸腔积液分为胸腔积液组(n=40)和无胸腔积液组(n=129)。回顾性分析多发性骨髓瘤患者合并胸腔积液的临床特征,采用Logistic回归分析MM患者发生胸腔积液的相关影响因素,通过Kaplan-Meier法对2组患者进行生存预后分析。结果:169例初诊多发性骨髓瘤患者中,胸腔积液发生率为23.67%。胸腔积液组患者年龄≥60岁及ISSⅢ期的比例(90.00%、70.00%)高于无胸腔积液组(71.32%、48.06%),差异有统计学意义(P=0.016、P=0.044)。胸腔积液组患者的血红蛋白水平和白蛋白水平[(75.58±21.40)g/L、(27.55±6.99)g/L]低于无胸腔积液组[(90.26±27.19)g/L、(34.25±7.04)g/L],差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,白蛋白水平为影响MM患者发生胸腔积液的独立危险因素(P=0.024)。Kaplan-Meier分析显示胸腔积液组中位OS 17个月,无胸腔积液组中位OS 46个月,差异有统计学意义(P<0.001)。结论:初诊多发性骨髓瘤患者合并胸腔积液并不少见,白蛋白水平为影响MM患者发生胸腔积液的独立危险因素,合并胸腔积液为多发性骨髓瘤患者生存的不良预后因素。Objective:To study the incidence,risk factors and prognostic significance of pleural effusion in newly diagnosed multiple myeloma(MM)patients.Methods:A total of 169 newly diagnosed multiple myeloma patients in Affiliated Hospital of Jiangsu University from January 2011 to January 2022 were included.They were divided into a pleural effusion group(40 cases)and a non-pleural effusion group(129 cases)according to whether pleural effusion developed on the first visit or in the first treatment cycle.Clinical features of multiple myeloma complicated with pleural effusion were retrospectively analyzed.Logistic regression analysis was employed to analyze the influencing factors related to the occurrence of pleural effusion in MM patients.Survival prognosis of the two groups were compared and analyzed by Kaplan-Meier method.Results:The incidence of pleural effusion in the 169 newly diagnosed MM patients was 23.67%.The rates of patients aged≥60 years and ISS III stage in the pleural effusion group(90.00%,70.00%)were significantly higher than those in the non-pleural effusion group(71.32%,48.06%)(P=0.016,P=0.044).The hemoglobin level and albumin level in the pleural effusion group(75.58±21.40 g/L,27.55±6.99 g/L)were significantly lower than those in the non-pleural effusion group(90.26±27.19 g/L,34.25±7.04 g/L)(P<0.05).Multiple logistic regression analysis showed that albumin level was an independent risk factor for pleural effusion(P=0.024).Kaplan-Meier analysis suggested that the median OS was significantly shorter in the pleural effusion group than that in the non-pleural effusion group(17m vs 46m,P<0.001).Conclusion:Pleural effusion is not an uncommon finding in newly diagnosed multiple myeloma.Albumin level is an independent risk factor for pleural effusion in MM patients.Pleural effusion is a poor prognostic factor for OS in multiple myeloma.

关 键 词：多发性骨髓瘤 胸腔积液 预后 

分 类 号：R733.3[医药卫生—肿瘤]