多发性骨髓瘤合并新型冠状病毒感染患者的临床特征分析  

Analysis of clinical features of multiple myeloma complicated with COVID-19

作　　者：徐云 颜灵芝[2] 施晓兰[2] 姚颖 王攀峰 颜霜[2] 孟佳佳 季楠 马骁[2] 傅琤琤[2] 吴德沛[2] XU Yun;YAN Lingzhi;SHI Xiaolan;YAO Ying;WANG Panfeng;YAN Shuang;MENG Jiajia;JI Nan;MA Xiao;FU Chengcheng;WU Depei(Department of Hematology,Soochow Hopes Hematology Hospital,Suzhou Jiangsu 215128,China)

机构地区：[1]苏州弘慈血液病医院血液科,苏州215128 [2]苏州大学附属第一医院血液科

出　　处：《中国感染与化疗杂志》2024年第2期176-183,共8页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(82270210)。

摘　　要：目的了解多发性骨髓瘤(MM)合并新型冠状病毒感染(COVID-19)的情况以及COVID-19患者的临床特征及转归。方法通过查询病例资料和电话随访,回顾性调研了2022年8月—2023年1月就诊于苏州弘慈血液病医院的MM患者在国内新型冠状病毒(新冠病毒)流行高峰期间COVID-19的发生率,重点收集了27例MM合并COVID-19住院患者的临床表现、实验室指标及预后信息,分析其临床特征。结果共调研116例MM患者,中位年龄69(38,86)岁,87例(75.0%)患者在流行高峰期间感染了新冠病毒:轻型12例(13.8%)、中型49例(56.3%)、重型20例(23.0%)、危重型6例(6.9%),合并COVID-19患者的死亡率为4.6%(4/87)。住院的27例患者中,男性16例(59.3%)。MM合并COVID-19初发临床表现主要为咳嗽26例(96.3%)、乏力20例(74.1%)、胸闷17例(63.1%)、咽痛17例(63.1%)、发热11例(40.7%)和头痛6例(22.2%)。27例患者合并的COVID-19均为中-危重型。感染新冠病毒后MM患者的白细胞和淋巴细胞计数均明显下降,而IL-6、CRP和D-二聚体则明显升高(P<0.05)。重/危重型较中型患者的淋巴细胞及血Na+水平下降更为明显;而D-二聚体、IL-6、LDH及CRP则升高(P<0.05)。MM合并COVID-19后患者的病毒抗体转阳中位天数为14(11,19)d,其中IgM抗体滴度中位数为3.25(2.06,4.69)S/CO,IgG抗体滴度中位数为6.41(2.06,9.50)S/CO。27例患者中新冠病毒抗原/核酸转阴的中位天数为22(16,30)d。25例(92.6%)好转出院,中位住院天数为20(11,33)d。结论MM合并COVID-19较2020年死亡率明显下降,但仍易进展为重型/危重型,病毒清除慢。Objective To understand the incidence,clinical features,and outcomes of COVID-19 in patients with multiple myeloma(MM).Methods The data of patients were collected by searching the hospital database and telephone follow-up to retrospectively investigate the incidence of COVID-19 in MM patients who visited Soochow Hopes Hematology Hospital from August 2022 to January 2023 during the peak period of COVID-19 in China.The data for analysis included clinical manifestations,laboratory test results,and outcomes,especially the data of 27 patients complicated COVID-19 pneumonia.Results A total of 116 MM patients were identified.The median age of these patients was 69 years old(range:38-86).Overall,87(75.0%)of the patients were complicated with COVID-19 during the epidemic peak,including mild cases(12,13.8%),moderate cases(49,56.3%),severe cases(20,23.0%),and critical cases(6,6.9%).The mortality rate was 4.6%(4/87)for the patients complicated with COVID-19.Overall,27 patients were admitted to hospital,including 16 males(59.3%).The initial symptoms of COVID-19 in MM patients were cough in 26 cases(96.3%),fatigue in 20 cases(74.1%),chest tightness in 17 cases(63.1%),pharyngalgia in 17 cases(63.1%),fever in 11 cases(40.7%),and headache in 6 cases(22.2%).All the 27 hospitalized patients had moderate to critical disease.COVID-19 was associated with significantly decreased levels of white blood cells and lymphocytes and significantly increased levels of IL-6,C-reactive protein(CRP)and D-dimer(P<0.05)in MM patients.The severe/critical patients showed significantly lower levels of lymphocyte count and serum Na+but significantly increased levels of D-dimer,IL-6,lactate dehydrogenase(LDH),and CRP compared to other patients(P<0.05).The median(P25,P75)time to positive conversion of anti�SARS-CoV-2 antibody was 14(11,19)days after infection in MM patients.The median titer of IgM antibody was 3.25(2.06,4.69)S/CO,and the median titer of IgG antibody was 6.41(2.06,9.50)S/CO.The median time from infection to negative conversion of novel c

关 键 词：多发性骨髓瘤 新型冠状病毒感染 临床特征 

分 类 号：R563.1[医药卫生—呼吸系统]