第505例——顽固性腹腔积液、M蛋白  

The 505th case:refractory ascites and monoclonal immunoglobulin

作　　者：张富婧 郑威扬 汪玄 蒋显勇 庄俊玲[1] Zhang Fujing;Zheng Weiyang;Wang Xuan;Jiang Xianyong;Zhuang Junling(Department of Hematology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院血液内科,北京100730 [2]中国医学科学院、北京协和医学院、北京协和医院消化内科,北京100730

出　　处：《中华内科杂志》2024年第5期517-520,共4页Chinese Journal of Internal Medicine

基　　金：首都卫生发展科研专项(2022-2-4013);中央高水平医院临床科研业务(2022-PUMCH-B-048)。

摘　　要：患者女,52岁,因反复腹胀、腹围增大半年余就诊。病初行腹腔积液穿刺及腹腔镜手术均无感染、实体瘤证据,同期诊断冒烟型多发性骨髓瘤。后因顽固性腹水、门静脉高压,行经颈静脉肝内门腔静脉分流术,效果欠佳。最终腹水流式细胞术发现异常单克隆浆细胞,进行性贫血,诊断多发性骨髓瘤。采用BCD方案(硼替佐米、环磷酰胺、地塞米松)抗浆细胞治疗后腹腔积液消失。A 52-year-old woman was admitted with a primary complaint of abdominal distension and increased abdominal circumference for more than half a year.There was no evidence of infection or solid tumor on abdominocentesis or laparoscopic surgery.Concurrently,smoldering multiple myeloma was diagnosed.Due to refractory ascites and portal hypertension,a transjugular intrahepatic portosystemic shunt was performed,but the efficacy was not satisfactory.As the anemia progressed,she was finally diagnosed with active multiple myeloma after monoclonal plasma cells were detected in the ascites by flow cytometry.Treated with a triplet regimen that included bortezomib,cyclophosphamide,and dexamethasone(BCD),she achieved a very good partial response and ascites regressed.

关 键 词：多发性骨髓瘤 腹水 抗浆细胞治疗 

分 类 号：R73[医药卫生—肿瘤]