多发性骨髓瘤合并肾损害患者的临床特征及相关危险因素分析.pdfVIP

C ·3235· 论 著 · 多发性骨髓瘤合并肾损害患者的临床特征及相关危险因素分析 王成玉，王 涵，廖蕴华，王明军 【摘要】 目的 探讨多发性骨髓瘤 (multiplemyeloma，MM)合并肾损害患者的临床特征及其相关危险因素。 方法 回顾性分析49例MM合并肾损害患者的临床特征及实验室检查，分析其中14例肾脏病理活检资料；以血肌酐 为肾损害的指标进行MM合并肾损害的相关因素分析。结果 MM合并肾损害的临床表现呈现多样性，以贫血、骨损 害、血压升高常见。肾脏病理表现多样，14例肾活检中肾小球系膜增生性病变5例，淀粉样变性 (ALD)4例，急性 肾小管损伤 2例，轻链沉积病 (LCDD)2例，管型肾病 (CastN)l例。血肌酐升高与高钙血症的发生率呈正相关 (OR=12．591，P=0．020)。结论 MM合并肾损害的临床表现复杂多样，以贫血、骨损害、血压升高常见；肾损害病 理类型多样，肾小球系膜增生性病变及淀粉样变性所 占比例较大。高钙血症是 MM患者以血肌酐升高为表现的肾损害 的独 立危 险因素。 【关键词】 多发性骨髓瘤；肾损害；骨髓瘤肾病；危险因素 【中图分类号】R733．3 【文献标识码】A 【文章编号】1007—9572 (2011)10—3235—03 ClinicalFeaturesofMultipleMyelomaPatients 、】Irith Kidney Lesion and theCorrelativeFactors WANG Cheng—y“， WANGHan，LIAOYun—hua，eta1．TheFirstAffiliatedHospitalofGuangxiMedicalUniversity，Nanning530021，China A【bstract】 0bjective Toexploretheclinicalfeaturesofpatientswithmuhiplemyeloma(MM)complicatedbykidney lesionandtherelativefactors．．Methods Theclinicalfeaturesandtheresultsoflaboratoryof49MM patientswithkidneylesion wereretrospectivelyanalyzed；andtherenalpathologybiopsydataof14ofthepatientswereanalyzed．Thecorrelativefactorsof MM patientswithkidneylesionwereanalyzed respectivelyaccordingtolevelofsernm creatinineastheindicatorofkidneyle· sion．Results TheclinicalmanifestationsofMM patientswithkidneylesionweremultifarious，withanemia，bonedamage，and elevatedbloodpressurebeingthecommonest．Pathologicaltypesofkidneylesionpresentedavarietyoftypes．Amongthe14cases ofrenalpathologybiopsy，thereweremesangialproliferativelesionsin5cases，amyloidosis(ALD)in4，acuterenaltubularin- juryin2，lightchaindepositiondisease(LCDD)in2，andcastnephropathy(CastN)in1．Therewasapositivecorrelationbe— tweenelevatedserumcreatinineandhypercalcemia(OR=12．591，P=0．020)．Conclusion TheclinicalmanifestationofMM patientswithkidneylesionwascomplexandvarious，howeve