多发性骨髓瘤肾功能不全的临床特征及危险因素分析

目的分析多发性骨髓瘤(Multiplemyeloma,MM)伴肾功能不全(renalfailure,RF)患者的临床特征,探索发生RF的危险因素。方法对MM伴发RF的91例患者进行回顾性分析,并与同期住院的165例肾功能正常MM对照研究,统计学方法采用卡方检验和logistic回归分析。结果91例中48(52．7％)例以肾损害为首发症状,其中30(62．5％)例延误诊治。与对照组比较,高血钙、高血尿酸、贫血、血M蛋白增高、溶骨性损害发生率均明显增加(P<0．05)。预后较对照组有明显差别：3月内病死率为26／91对14／165(P<0．0001)．3月～1年病死率为14／91对12／165(P<0．05),生存期超过1年的为18／91对95／165(P<0．0001)。回归分析显示发生RF的危险因素包括肾毒性药物的应用史、中重度贫血、血M蛋白增高、男性、高钙血症。结论肾功能不全是MM的早期并发症,容易引起误诊,这类患者确诊MM时病情往往较重,并发症多,预后差。对贫血重、伴有高血钙、曾用肾毒性药物的MM患者,应警惕RF的发生。

Clinical Features of Renal Insufficiency due to Multiple Myeloma andRelated Risk Factors

Objective: To study clinical featuresof the patients with multiple myeloma (MM) accompanied by renalinsufficiency and investigate the related risk factors of renalimpairment. Methods: A control study of clinicalcharacteristics was performed between 91 patients with renalinsufficiency due to MM and 165 patients with normal renalfunction in MM during the same period. The data were statisticallyanalyzed by chi-square test and logistic regression analysis.Results: Renal insufficiency was the initialpresentation in 48 (52.7%) of the 91 patients, and 30(62.5%) of the 48 patients were misdiagnosed. The prognosis ofgroup with renal insufficiency was significantly poorer than thatof group with normal renal function: mortality in 3 months, 3months--1 year was 26/91 vs 14/165 (P<0.0001), 14/91 vs 12/165(P<0.05) respectively, and patients survived 1 year was18/91 vs 95/165 (P<0.0001). The incidence of hypercalcemia,hyperuricemic, severe anemia, high serum M-protein concentrationand lytic bone lesions were significantly higher in renalinsufficiency group than those in control group (P<0.05).Logistic regression analysis identified 5 risk factors of renalimpairment, including, severe anemia (Exp()=13.819, P<0.0001), use of nephrotoxic drugs(Exp()=6.217, P=0.001), high serum M-proteinconcentration (Exp()=5.026, P=0.001), male(Exp()=3.745, P=0.006), and hypercalcemia(Exp()=3.472, P=0.006), but age, serum densityof uric acid, type of serum M-protein, and Bence Jones proteinuriawere not significantly associated with renal insufficiency.Conclusion: Renal insufficiency was a common earlycomplication of MM, which often resulted in misdiagnosis. Thestatus of these patients tended to be very bad, with many othercomplications, when MM was diagnosed, so their prognosis was poor.The occurrence of renal insufficiency in patients with MM andhypercalcemia, severe anemia, high serum M-protein concentration,especially use of nephrotoxic drugs should be alert.