新诊断多发性骨髓瘤肾功能亚型组间细胞遗传学及生化特点比较

目的:分析新诊断多发性骨髓瘤肾功能亚组间细胞遗传学及生化特点。方法:回顾409例新诊断多发性骨髓瘤患者,分析肾功能组间细胞遗传学等生化资料。结果:409例患者中,肾功能不全（renal insufficiency,RI）组占32.2%,与肾功能正常（no-RI）组相比,RI组男女比例、DS分期Ⅲ期、ISS分期Ⅲ期、β2微球蛋白、校正血清钙、乳酸脱氢酶明显增高,RI组血红蛋白、血清白蛋白更低(P均＜0.05)。两组免疫分型均以IgG型为主,但no-RI组比例增高,RI组轻链型比例高于no-RI组。多因素Logistic回归分析结果最后显示β2微球蛋白、白蛋白、乳酸脱氢酶是RI发生的危险相关因素。82例进行细胞遗传学检测,RI与no-RI组相比检测阳性率无差异,分别为58.3%和67.2%(P=0.443);在高危细胞遗传学异常中也无明显差异,分别为25%和34.4%(P=0.401)。结论:在新诊断多发性骨髓瘤中肾功能不全与细胞遗传学异常无关,但是与β2微球蛋白、白蛋白、乳酸脱氢酶相关。     

肾功能对多发性骨髓瘤患者疲劳状态及预后的影响

目的 探讨肾功能对多发性骨髓瘤(MM)患者疲劳状态及预后的影响.方法 根据是否发生肾功能损伤将42例MM患者分为无肾功能损伤组(n=23)和肾功能损伤组(n=19).在采取同样治疗方法的情况下,比较两组患者的实验室指标(血钙、血红蛋白及乳酸脱氢酶)、疲劳状态[多维疲劳量表(MFI)]及生存情况.结果 无肾功能损伤组患者...     

多发性骨髓瘤患者校正血钙的临床意义

目的:分析多发性骨髓瘤校正血钙的临床意义。方法:检测98例初发骨髓瘤患者的血钙水平,用同时采集静脉血所得血清白蛋白浓度分别带入两个公式进行校正,比较校正前后及两个校正值的血钙水平。结果:经两个公式校正后高钙血症发生率比校正前均显著升高(P<0.01),经公式1和2校正后的两组高钙血症无显著性差异。多发性骨髓瘤Ⅰ期患者血钙水平校正前为(2.249±0.073)mmol/L,经公式1校正后为(2.324±0.132)mmol/L,经公式2校正后为(2.389±0.106),校正前后及校正后的两组值之间均无显著差异(P>0.05)。Ⅱ期患者血钙水平校正前为(2.263±0.272)mmol/L,经公式1校正后为(2.510±0.259)mmol/L,经公式2校正后为(2.453±0.258),校正前与两组校正后数值均有显著性差异(P<0.01),校正后的两组值之间无显著差异(P>0.05)。Ⅲ期患者血钙水平校正前为(2.379±0.392)mmol/L,经公式1校正后为(2.584±0.422)mmol/L,经公式2校正后为(2.531±0.416),校正前与两组校正后数值均有显著性差异(P<0.01),校正后的两组值之间无显著差异(P>0.05)。A、B两组骨髓瘤患者血钙浓度具有显著性差异(P<0.01),校正后的两组值之间无显著差异(P>0.05)。结论:本文所选患者中经白蛋白校正的高血钙的发生率,与国外文献报道并不低。校正血钙更敏感地反映疾病的严重程度,高血钙与肾功能不全存在相关性,两个校正公式校正血钙值无差异。     

形态学分类和临床变数对评估年老组和年轻组多发性骨髓瘤患者预后的意义

在判断多发性骨髓瘤患者预后方面下列因素是有价值的:病期、血红蛋白、血小板计数、肾功能、血清钙、血浆白蛋白、乳酸脱氢酶(LDH)、C反应蛋白(CRP)、轻链类型、骨髓中浆细胞百分数。除此以外,标记指数、DNA和RNA的含量、染色体核型、β_2微球蛋白、白介素2和白介素6也都是判断预后有价值的因素,但是,由于检测方法复杂,所以很少被采用。此外,光学显微镜中浆细胞的成熟程度和电子显微镜中浆细胞核浆发育不平衡的程度均与骨髓瘤患者的预后有关。本研究分析影响年老组(≥65岁)和年轻组(<65岁)骨髓瘤患者预后的各因素,特别涉及形态学方面。     

多发性骨髓瘤合并肾功能不全患者的临床特点

目的 探讨多发性骨髓瘤合并肾功能不全患者的临床特点.方法 随机抽取102例MM患者的临床资料,按照患者出现肾功能不全的时间不同分为A组、B组、C组.A组34例,B组12例,C组56例.A组患者在初诊时发现合并肾功能不全;B组患者为初诊时无肾功能不全者,在疾病进展过程中出现肾功能不全;C组为疾病治疗过程中未出现肾功能不全的患者.观察患者临床表现、免疫分型及临床疗效.结果 A组和B组患者Scr、血清钙、UA、β2-MG、浆细胞水平显著高于C组,差异有统计学意义(P＜0.05).A组LDH水平显著低于B组,差异有统计学意义(P＜0.05).46例合并肾功能不全的患者中,IgAλ轻链型的比例显著高于IgAk轻链型,差异有统计学意义(P＜0.05).C组中位生存期显著高于A组和B组,差异有统计学意义(P＜0.05).结论 多发性骨髓瘤合并肾功能不全患者临床表现为高水平的Scr、血清钙、UA、β2-MG、浆细胞,而且IgAλ轻链型的比例较高.     

多发性骨髓瘤合并高钙血症的临床分析

目的分析多发性骨髓瘤(MM)合并高钙血症的临床特征。方法回顾性分析96例MM的临床资料,比较分析MM合并高钙血症患者与未合并高钙血症患者的临床特征。结果 96例MM患者中,16例(16.7%)血清钙水平>2.6 mmol/L,经血清白蛋白校正后,22例(22.9%)血钙水平>2.6 mmol/L,与未合并高钙血症的患者比较,合并高钙血症MM患者更易出现溶骨性损害(OR 2.3,95%CI 0.27-19.81)、肾功能损害(OR 2.12,95%CI 0.63-7.17)、高乳酸脱氢酶血症(OR 5.15,95%CI 1.34-19.81)、β2微球蛋白升高(OR 7.92,95%CI 0.45-140.54)、贫血(OR 1.27,95%CI0.49-3.29)和ISS分期为Ⅲ期(OR 3.08,95%CI 1.01-9.37)。结论 MM合并高钙血症的发生率高,其发生可能与MM病情进展有关。     

淋巴细胞绝对计数与多发性骨髓预后的相关性分析

  目的  探讨淋巴细胞绝对计数与多发性骨髓瘤患者疾病进展和预后的相关性。  方法  收集102例初发多发性骨髓瘤患者的淋巴细胞绝对计数及各项临床指标,分析淋巴细胞绝对计数与多发性骨髓瘤患者疾病进展和预后的相关性。  结果  根据中位淋巴细胞绝对计数分组后得出,组1（淋巴细胞绝对计数＞1.51×109/L）发病年龄、血清乳酸脱氢酶和β2-微球蛋白明显低于组2（淋巴细胞绝对计数 < 1.51×109/L）,组1患者中位总生存期大于组2（P < 0.05）。但两组患者性别、白蛋白、D-S分期、ISS分期、分组和疗效差异无统计学意义（P>0.05）。  结论  初发时淋巴细胞绝对计数高的患者预后较好,淋巴细胞绝对计数低的患者预后较差。推测淋巴细胞绝对计数可能成为多发性骨髓瘤的独立预后因素之一。      

多发性骨髓瘤合并骨折患者的临床和随访资料分析

目的:了解多发性骨髓瘤合并骨折患者的临床生化特点和生存情况。方法:回顾分析30例长期生存的多发性骨髓瘤患者的临床生化特点,比较是否合并骨折患者的生化检测指标、生活质量、预后和生存状态。结果:两组患者的生化指标无明显差异(P>0.05)。骨折患者的ECOG评分均为3-4分,不合并骨折的患者ECOG评分为0-1分,二者相比差异有显著性(P<0.05);骨髓原始浆细胞比例、β-2微球蛋白、白蛋白、肾功能、骨折、贫血、年龄、性别、诱导治疗效果等多因素分析,骨折不是预后的影响因素。结论:常见血液生化指标,不能反映和预测骨髓瘤骨病骨折发生;预防骨折可以改善生活质量。     

17号染色体缺失与乳酸脱氢酶相关性研究及其对多发性骨髓瘤预后的影响

目的：分析del（17p13）（TP53）与多发性骨髓瘤患者临床资料的关系及其对预后的影响。方法：收集56例初诊多发性骨髓瘤患者临床资料,并对其骨髓标本行荧光原位杂交（ fluorescence in situ hybridization, FISH）检测。统计软件采用SPSS 19.0,研究del（17p13）与临床基本资料间的关系使用卡方检验,与实验室检查指标间的关系使用t检验。生存分析使用Kaplan-Meier法。结果：初诊多发性骨髓瘤（ multiple myeloma, MM）患者del（17p13）缺失的检出率为21.43%。Del（17p13）与乳酸脱氢酶（ lactate dehydrogenase,LDH）水平相关联（ P＝0.034）,与性别、年龄、分型、D-S分期、ISS分期、血小板、白蛋白、球蛋白、β2微球蛋白、尿素氮、血肌酐、血钙、骨髓瘤细胞比例无关。Del（17p13）患者的无进展生存期（ progression free survival,PFS）及总生存期（overall survival,OS）均较未缺失者显著缩短（P﹤0.05）。结论：本研究发现del（17p13）与部分临床特征相关,del（17p13）的MM患者预后不良。     

多发性骨髓瘤相关肾损害的危险因素

目的:分析多发性骨髓瘤相关肾损害的危险因素。方法:回顾性分析2009年1月-2013年12月我院收治的多发性骨髓瘤89例患者资料。将患者分为A组（肾功能正常）57例,B组（肾功能损害）32例,各因素首先采取单因素分析,对具有统计学意义的因素进一步采取非条件多因素Logistic回归分析。结果:单因素分析显示,两组患者Hgb、血Ca、血P、血URIC、血清β2-MG、尿本周氏蛋白、轻链类型、感染以及肾毒性药物九个因素比较,差异具有统计学意义（P＜0.05）。对上述单因素具有统计学意义的八个因素进行多因素Logistic回归分析,血Ca、轻链类型以及Hgb三个因素进入回归模型（P＜0.05）。结论:肾损害是多发性骨髓瘤患者的主要表现,高血钙、单克隆免疫球蛋白游离轻链类型以及贫血是多发性骨髓瘤患者发生相关性肾损害的独立危险因素。     

Chemical and hematological screening in patients with malignant and non-malignant conditions

The value of multiphasic automated laboratory tests in differentiating stages of malignancy and in detecting recurrence of cancer was studied. Chemical SMA-12 tests (including calcium, phosphate, glucose, BUN, uric acid, cholesterol, total protein, albumin, total bilirubin, alkaline phosphatase (AP), lactic dehydrogenase (LDH) and SGOT) and hematological SMA-4 tests (including hematocrit, hemoglobin, WBC and RBC counts) were performed in 1,578 patients. Baseline data obtained from 582 patients with benign, and 996 patients with malignant, lesions were subdivided according to age, sex, primary site, and extent of cancer. With advancing stages of cancer, there was a significant increase of AP and LDH, but decrease of albumin and hemoglobin. Among patients who had sequential tests, there was a significant decrease of uric acid and LDH with control of cancer, and increase of AP with development of distant dissemination.     

Decreased HDL-Dependent Paraoxonase and Arylesterase Enzyme Activity May Indicate a Worse Prognosis in Multiple Myeloma

Background: Multiple myeloma (MM) is a haematological cancer characterized by clonal proliferation ofplasma cells.The aim of this study was to investigate the activity of serum paraoxonase-1 (PON1) and arylesterase(ARE) in multiple myeloma with and without free light chain excretion(FLCe-MM and NFLCe-MM); as wellas to investigate possible alterations in oxidative stress parameters. Materials and Methods: Total thiol (T.thl),oxidative stress index (OSI), total oxidant status (TOS) and total antioxidant status (TAS) were examined inaddition to the PON1 and ARE enzyme activities in twenty one FLCe-MM and nineteen NFLCe-MM subjects.Routine parameters like lipid panel, serum total protein, albumin, creatinine, blood urea nitrogen (BUN), uricacid and hemoglobin levels were compared with the oxidative stress markers. Results: Serum total protein, BUN,creatinin, and uric acid levels were significantly higher (p=0.04, p=0.001, p=0.001 and p=0.0022, respectively), whilehemoglobin and albumin levels were significantly lower in FLCe-MM patients (p=0.009 and p=0.04,respectively).PON1 and ARE activities were significantly lower in patients with FLCe-MM compared to those with NFLCe-MM (p=0.001 and p=0.008, respectively). Conclusions: Depending on our results of prognostic markers of MMsuch as age, hemoglobin, albumin, and creatinine we feel confident to presume FLCe-MM as a subgroup witha worse prognosis. A decrease in PON1 and ARE activities may contribute to the prognosis and may be used asa prognostic tool in MM.     

结外鼻型NK/T细胞淋巴瘤30例诊疗分析

目的 探讨结外鼻型NK/T细胞淋巴瘤的临床特征及预后影响因素.方法 对按照WHO淋巴瘤分类标准,经病理确诊的30例结外鼻型NK／T细胞淋巴瘤患者临床特点、长期生存率、预后因素进行分析.结果 30例结外鼻型NK/T细胞淋巴瘤患者,以男性患者居多,中位发病年龄45岁,年轻患者鼻外型较多见,且更易合并噬血细胞综合征.实验室检查发现白细胞、血红蛋白、血小板、丙氨酸氨基转移酶、乳酸脱氢酶、清蛋白常有异常,且在生存组与死亡组之间,血红蛋白下降、血清清蛋白下降程度的差异有统计学意义.死亡患者发病年龄相对较轻,鼻外型多见,更多伴B症状、噬血细胞综合征,国际预后指数（IPI）评分较高,骨髓累及发生率较高,临床分期更晚,实验室检查异常更多.Kaplan-Meier单因素分析显示发病年龄、是否鼻腔来源、有无B症状、有无骨髓累及、是否伴发噬血细胞综合征、IPI评分、临床分期、治疗方法,以及有无白细胞、血红蛋白、血小板、血清乳酸脱氢酶、清蛋白水平异常,有无肝功能损伤等因素,均可影响预后;采用Cox回归模型进行多因素预后分析,显示有无血清LDH升高及有无骨髓累及为影响预后的独立危险因素.结论 结外鼻型NK/T细胞淋巴瘤多见于中年男性,侵袭性高,病初临床表现多样.相比鼻腔NK/T细胞淋巴瘤患者,鼻外型患者发病年龄更轻,实验室异常更明显,更易伴发噬血细胞综合征,更易累及骨髓,预后更差.有无血清LDH升高及有无骨髓累及为影响预后的独立危险因素.     

Hypercalcemia, renal failure, and relapse in multiple myeloma

Forty-two patients with multiple myeloma that responded to initial treatment were observed for at least 6 months during a 2-year period. Eleven deaths occurred, seven of these being associated with hypercalcemia. None of these patients developed renal insufficiency before the serum calcium level rose, although kidney function deteriorated later in five of them. In those patients who are susceptible, hypercalcemia appears to be a good early indicator of relapse in multiple myeloma.     

Ki-67 Immunostaining and its Correlation with Microvessel Density in Patients with Mutiple Myeloma

Purpose: To compare Ki-67 index and microvessel density MVD) in multiple myeloma and non-myeloma patients and their correlation with each other and other prognostic markers. Materials and Methods: Forty patients were enrolled in this study between 2011-2013, 30 with multiple myelomas and 10 with non-malignant disease as controls. Proliferative activity was analyzed by Ki-67 and microvessel density (MVC) was assessed by CD34 and compared between two groups. In myeloma patients, correlation between Ki-67, MVD and other prognostic factors was assessed by Pearson correlation coefficient. Results: According to Durie Salmon staging criteria, 13 patients were of stage 1, 5 of stage II and 12 of stage III. Ki-67 expression showed a positive correlation with MVD (r=0.729, <0.001) and was significantly higher (<0.0001) in myeloma patients (range 35-80%, mean 60.1 %) as compared to controls (range 8-25%, mean 18.1%). MVD/mm2 was also significantly (<0.0001) higher in myeloma patients (range 62-237/mm2, mean 178.0/mm2) than controls (range 5.2-50/mm2, mean 18.3/mm2). Ki-67 and MVD, both increased progressively with increasing stage of myeloma. Ki-67 showed significant positive correlation with blood urea and lactate dehydrogenase and a significant negative correlation with serum albumin. MVD showed a significant positive correlation with blood urea, lactate dehydrogenase, serum creatinine, 2 microglobulin and skeletal lesions. Conclusions: Ki-67 and MVD are indicators of aggressiveness and poor prognosis having significant correlation with each other and other prognostic markers of multiple myeloma. Routine assessment of these markers may help to identify high risk patients, who may benefit from with more aggressive therapy.     

血清CysC、Cr及LDH水平变化诊断多发性骨髓瘤早期肾损伤的价值

目的:研究多发性骨髓瘤早期肾损伤患者血清胱抑素C（CysC）、肌酐（Cr）及乳酸脱氢酶（LDH）变化的价值,为临床诊断提供参考。方法:回顾性分析我院及西安交通大学第二附属医院于2016年1月至2018年1月期间收治的40例多发性骨髓瘤患者的临床资料作为观察组,另选取同期来院参加体检的健康志愿者40例作为对照组。对比两组受检者的血清CysC、Cr及LDH水平,并分析其诊断及联合诊断特异度及灵敏度。结果:两组间相比,观察组患者的血清CysC、Cr及LDH水平明显高于对照组,差异有统计学意义（P<0.05）。两组间相比,观察组患者的血清CysC、Cr及LDH阳性率分别为62.5%、42.5%、60.0%,均高于对照组,差异有统计学意义（P<0.05）。而诊断效能对比,CysC、Cr及LDH三者联合检测的灵敏度最高,可达到95.0%。结论:多发性骨髓瘤早期肾损伤患者血清CysC、Cr及LDH水平及阳性率均明显升高,且三者联合诊断灵敏度最高,值得临床借鉴。     

多发性骨髓瘤肾损害的临床特征和相关因素分析

目的分析多发性骨髓瘤肾损害的临床特征,探讨其发生肾损害的相关因素。方法对84例多发性骨髓瘤患者的实验室检查结果和临床特征进行回顾性分析。结果多发性骨髓瘤患者的肾损害发生率为53.6%。临床症候群为孤立性蛋白尿、肾功能不全、溶骨性损害、中重度贫血、M蛋白阳性、高血压和尿苯周氏蛋白阳性。发生肾损害的独立危险因素为中重度贫血、高钙血症、血清M蛋白水平和男性。结论多发性骨髓瘤肾损害临床特征以孤立性蛋白尿最为常见,其次为肾功能不全。中重度贫血、高钙血症、血清M蛋白水平及男性是多发性骨髓瘤肾损害主要危险因素。     

Hyperuricemia in Patients with Cancer

Hyperuricemia is a common early complication in patients with hematological malignancies treated with intensive chemotherapy. It results from the breakdown of nuclear proteins leading to increased blood levels of hypoxanthine and xanthine. These compounds are degraded into uric acid by the enzyme xanthine oxidase. Because the mechanisms of excretion of uric acid are limited in humans and blood levels are near saturation level, a common complication of hyperuricemia is renal failure resulting from the deposition of uric acid in renal tubules. When renal insufficiency occurs in conjunction with other metabolic aberrations, such as hyperkalemia, hyperphosphatemia, and hypocalcemia, this process is termed tumor lysis syndrome. Patients with acute lymphoblastic leukemia and non-Hodgkin’s lymphoma, particularly Burkitt’s lymphoma, are at greatest risk because of the high sensitivity of the cells to chemotherapy. Other factors associated with increased risk of hyperuricemia and tumor lysis syndrome include hyperleukocytosis, massive organomegaly, renal enlargement, extrinsic compression of the genitourinary tract, and elevated serum lactate dehydrogenase activity. Conventionally, patients at risk of developing hyperuricemia receive alkalinized fluids and allopurinol, an inhibitor of the enzyme xanthine oxidase. These measures have been effective in reducing mortality associated with metabolic complications during tumor lysis in the majority of the cases. However, as many as 25% of patients at high-risk of developing tumor lysis syndrome require dialysis, and some of them have the treatment course altered because of these complications. Recently, a synthetic recombinant form of the enzyme urate oxidase, rasburicase has become available in the US. This enzyme acts directly on urate and degrades it to allantoin, a much more soluble compound.     

硼替佐米为主方案与常规化疗方案治疗多发性骨髓瘤疗效比较

目的:评估以硼替佐米为主方案及常规化疗方案对初发多发性骨髓瘤（MM）患者的疗效,并分析其影响生存的预后因素。方法:72例MM患者分别采用5种化疗方案,硼替佐米联合地塞米松（BD方案）,硼替佐米联合吡喃阿霉素和地塞米松（BTD方案）,长春新碱联合吡喃阿霉素和地塞米松（VTD方案）,马法兰、泼尼松(MP)方案,马法兰、泼尼松联合沙利度胺（MPT方案）,BD及BTD方案疗程的第 1、4、8、11天给予硼替佐米 1.3mg／m2 静脉注射,患者均接受了4-6个疗程的治疗。结果:72例患者随访期为6-54个月,中位随访期为32个月;治疗后BD、BTD、VTD、MP、MPT组中位PFS分别为26.6、28.1、19.5、17.4、20.5个月;中位OS分别为44.1、48.2、24.3、22.7、27.6个月。使用BD+BTD方案患者总ORR为85.29%（29/34）;VTD方案ORR为 58.33％(7/12);MP方案ORR为 41.67％(5/12);MPT方案ORR为 50.00％(7/14)。单因素和多因素分析均显示,治疗后是否获得完全缓解或非常好的部分缓解是影响患者生存的因素,而M蛋白分型、年龄、Durie-salmon分期、高血清肌酐、低血红蛋白、低白蛋白、高β2-微球蛋白、高乳酸脱氢酶均与预后无关。治疗中主要不良反应有血小板减少、外周神经病变、中性粒细胞减少、贫血、腹泻、转氨酶升高等。结论:硼替佐米为主方案治疗初发MM较常规化疗方案疗效显著,患者的耐受好,可消除传统认为的不良预后因素对生存的影响,是一种值得推荐的治疗MM安全、有效及可靠的方法。