血浆置换频率和量对多发性骨髓瘤合并肾衰竭患者M蛋白清除率作用的探讨

目的 探讨血浆置换频率和量对多发性骨髓瘤合并肾衰竭患者M蛋白清除率的作用.方法 选择22例多发性骨髓瘤合并肾功能不同程度损伤并在化疗期间进行血浆置换的患者,分为3组:第1组(M蛋白平均值80g/L组)每日置换1次,置换量为1500 ml,连续5 d;第2组(M蛋白35 g/L组)每日置换1次,置换量为1500 ml,连续5 d;第3组(M蛋白35 g/L组)隔日置换1次,置换量为800 ml,连续5 d.每组分别在置换3 d和5 d后检测血液中M蛋白的含量.结果 第1组M蛋白3 d后下降54.3%,5 d后下降78.5%;第2组M蛋白3 d后下降49.7%,5 d后下降79.7%;第3组M蛋白3 d后下降37.1%,5 d后下降45.7%.结论 在使用有效化疗的同时,连续血浆置换且置换量大,可迅速降低患者血中的M蛋白,减少肾衰竭的发生.

Study on the relationship between the clearance of M protein and the frequency as well as the volume of plasma exchange in the treatment of multiple myeloma patients with renal failure

Objective To investigate the relationship between the rapid clearance of M protein by plasma exchange and renal failure in patients with multiple myeloma. Methods Twenty-two cases of multiple myeloma with uarious extent of renal malfunction who received plasma exchange treatment during chemotherapy period were divided into three groups. In the first group, the average value of M protein was 80 g/L and this group was given 1500 ml plasma exchange once a day for five consecutive days. In the second group the average value of M protein was 35 g/L and was given 800 ml plasma exchange every other day for 3 time. M protein of each was measured on the third and fifith day after plasma exhange. Results Reduction of M protein in day 3 and day 5 of each group was different: 54.3% and 78.5% in the first group; 49.7% and 79.7% in the second group; 37.1% and 45.7% in the third group respectively. Renal function of each group was followed up for 2 years. Conclusions Large volume and continuous plasma exchange can decrease M protein rapidly and reduce the incidence of renal failure while patients are receiving effective chemotherapy.