2021 年第 3 期 第 16 卷

老年多发性骨髓瘤合并肾损伤患者的病理特征及危险因素分析

Pathological features and risk factors of multiple myeloma complicated with renal injury in the elderly patients

作者：黄昭萍杨灿华

英文作者：Huang Zhaoping Yang Canhua

单位：广西医科大学附属武鸣医院血液内科，南宁530199

英文单位：Department of Hematology Wuming Hospital of Guangxi Medical University Nanning 530199 China

关键词：多发性骨髓瘤；肾损伤；危险因素分析

英文关键词：Multiplemyeloma;Renalinjury;Riskfactoranalysis 

• 摘要：

• 目的 探讨老年多发性骨髓瘤（MM）合并肾损伤患者的病理特征及其危险因素。方法 收集2013年10月至2020年10月广西医科大学附属武鸣医院收治的98例老年MM患者的临床资料，根据是否继发肾损伤分为肾损伤组（43例）和肾功能正常组（55例），分析MM合并肾损伤患者的病理特征及危险因素。结果 MM合并肾损伤临床表现呈现多样性，首发症状以贫血、感染和骨关节痛多见，肾脏受累表现均有肾功能不全，并伴有大量蛋白尿、高尿酸血症及高钙血症。肾脏病理检查：管型肾病16例（37.2%）；单克隆丙种球蛋白病15例（34.9%），其中淀粉样变性14例、轻链沉积病1例；其余的病理类型有肾小球基底膜增生性病变5例（11.6%）、间质纤维化3例（7.0%）、肾小管上皮细胞空泡样变性2例（4.7%）、肾小管萎缩2例（4.7%）。多因素Logistic回归分析结果显示，贫血(比值比=5.562，95%置信区间：2.116～14.618，P=0.001)、血清校正钙(比值比=5.646，95%置信区间：2.464～12.937，P<0.001)、高尿酸血症（比值比=4.821，95%置信区间：1.479～15.719，P=0.009）、血β2微球蛋白（比值比=5.726，95%置信区间： 2.083～15.742，P=0.001）、乳酸脱氢酶（比值比=6.197，95%置信区间：1.523～25.213，P=0.011）是MM合并肾损伤的危险因素。血红蛋白、血清校正钙、血尿酸、血β2微球蛋白、乳酸脱氢酶敏感度和特异度均较高，在MM合并肾损害的预测中，具有一定的诊断效能。结论 MM合并肾损伤临床表现复杂多样、肾损伤病理类型多样化，贫血、高血清校正钙、高尿酸血症、β2微球蛋白及乳酸脱氢酶升高均为MM合并肾损伤的危险因素。

• Objective To investigate the pathological features and risk factors of elderly patients with multiple myeloma(MM) complicated with renal injury. Methods The clinical data of 98 elderly MM patients admitted to Wuming Hospital of Guangxi Medical University from October 2013 to October 2020 were collected. The patients were divided into renal injury group(43 cases) and normal renal function group(55 cases) according to whether complicating with secondary renal injury. The clinical features and related risk factors of MM patients with renal injury were analyzed. Results The clinical manifestations of MM complicated with renal injury were diverse, the first onset symptoms were mostly anemia, infection and bone and joint pain, and the renal involvement was all characterized by renal insufficiency, with a large amount of proteinuria, hyperuricemia and hypercalcemia. Renal pathological examination showed that, there were 16 cases(37.2%) of cast nephropathy and 15 cases(34.9%) of monoclonal gammopathy, including 14 cases of amyloidosis and 1 case of light chain deposition disease. The remaining pathological types included 5 cases(11.6%) of glomerular basement membrane proliferative lesions, 3 cases(7.0%) of interstitial fibrosis, 2 cases(4.7%) of vacuollike degeneration of renal tubular epithelial cells, and 2 cases(4.7%) of renal tubular atrophy. Multivariate Logistic regression analysis showed that anemia［odds ratio(OR)=5.562, 95% confidence interval(CI): 2.116-14.618, P=0.001］, serum corrected calcium(OR=5.646, 95%CI: 2.464-12.937, P<0.001), hyperuricemia (OR=4.821, 95%CI: 1.479-15.719, P=0.009), serum β2-microglobulin(OR=5.726, 95%CI: 2.083-15.742, P=0.001) and lactate dehydrogenase (OR=6.197, 95%CI: 1.523-25.213, P=0.011) were risk factors of MM complicated with renal injury. Hemoglobin, serum corrected calcium, serum uric acid, serum β2-microglobulin and lactate dehydrogenase had high sensitivity and specificity, which could be used to predict MM with renal damage. Conclusions The clinical manifestations of MM complicated with renal injury are complex and diverse, and the pathological types of renal injury are diverse. Anemia, high serum corrected calcium, hyperuricemia, β2-microglobulin and elevated lactate dehydrogenase are risk factors of MM complicated with renal injury.