血浆置换－血液净化治疗多发性骨髓瘤并发肾衰竭患者的诊疗分析

目的观察血浆置换－血液净化治疗多发性骨髓瘤（MM）并发肾衰竭患者的疗效。方法MM并发急性肾衰竭患者34例，其中男性19例，女性15例；年龄42～75岁，平均年龄54岁。采用HA130灌流器（珠海丽珠医用公司），对其进行血浆置换－血液净化治疗。每3天行1次血浆置换－血液净化治疗，3次为1疗程。统计分析治疗前后的尿素氮、血肌酐（SCr）、每日尿量。结果共进行96次血浆置换－血液净化。治疗有效者22例，其中包括肾功能逆转17例，5例发展为慢性尿毒症，无效者12例（其中死亡患者2例，主动出院者3例）。尿素氮、SCr治疗后均显著下降；治疗前后比较，差异有显著统计学意义（P〈0．001）。每日尿量从（924．32±543．26）mL下降到（331．24±321．01）mL；治疗前后比较，差异有显著统计学意义（P〈0．001）。中重度贫血29例中缓解24例（82．8％）；差异有显著统计学意义（P〈0．001）。免疫球蛋白IgG型患者治疗后17例有效。结论血浆置换－血液净化治疗MM并发肾衰竭可以延长患者生存时间，促进急性肾衰竭完全康复，提高患者生活质量。

Diagnosis and analysis of plasma exchange-blood purification treatment in multiple myeloma patients with renal failure

Objective To observe the curative effect of plasma exchange-blood purification treatment for patients with multiple myeloma（MM） with kidney failure. Methods A total of 34 MM patients with acute renal failure were enrolled, male 19, female 15, aged 42 - 75 years old, mean age 54 years old. The plasma exchange-blood purification was performed every 3-day. Each treatment course included 3 times HA130 perfusion apparatus. The urea nitrogen, serum creatinine（SCr） and daily urine output were analyzed. Results A total of 96 times of plasma exchange-blood purification were performed. There were 22 cases of effective treatment effects, which included 17 cases with kidney reversals, 5 cases with development of chronic uremia. The invalid 12 cases showed ineffective treatment effects which included 2 deaths and 3 discharges. Compared with the results of pre-treatment, the urea nitrogen and SCr after treatment were significantly decreased （P 〈 0.001）. The daily urine decreased from （924.32 ± 543.26） mL before treatment to （331.24 ± 321.01） mL （P 〈 0.001） after treatment. Among the 29 patients with moderate-severe anemia, conditions improved in 24 cases（82.8 %）（P 〈 0.001）. The immune globulin IgG type were 19 cases, 17 cases were effective. Conclusion It is demonstrated that plasma exchange-blood purification for treating MM with kidney failure patients could prolong survival time, acute renal failure, promote a full recovery and improve their quality of life.