本文選題：單克隆免疫球蛋白血癥 + 多發(fā)性骨髓瘤�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討單克隆免疫球蛋白血癥(monoclonal gammopathy of undeter mined significanees,MGUS)、多發(fā)性骨髓瘤(multiple myeloma,MM)患者的臨床指標(biāo)的差異,指導(dǎo)臨床早期診斷;分析多發(fā)性骨髓瘤伴腎功能不全患者的危險(xiǎn)因素,早期預(yù)防。方法:選擇2012年—2016年在廣西醫(yī)科大學(xué)第一附屬醫(yī)院住院診斷為單克隆免疫球蛋白血癥的患者14例,及多發(fā)性骨髓瘤的患者225例,比較兩者的臨床、病理特點(diǎn);回顧性分析多發(fā)性骨髓瘤伴腎功能不全患者的危險(xiǎn)因素和不同方案治療后腎臟轉(zhuǎn)歸情況。結(jié)果:1.單克隆免疫球蛋白血癥患者中男性占57.1%,多發(fā)性骨髓瘤男性占61.8%。單克隆免疫球蛋白血癥、多發(fā)性骨髓瘤發(fā)病平均年齡分別是(54.5±6.79)歲、(60.84±9.34)歲。首發(fā)臨床癥狀上,單克隆免疫球蛋白血癥以貧血、骨痛、水腫多見(jiàn)(28.57%、21.43%、21.43%),多發(fā)性骨髓瘤以骨痛最多見(jiàn)(59.11%),其次為貧血癥狀(16.89%)。2.兩組疾病患者尿蛋白陽(yáng)性率、尿潛血陽(yáng)性率無(wú)差異;單克隆免疫球蛋白血癥患者中24小時(shí)尿液蛋白定量中位數(shù)為362.95mg/24h,多發(fā)性骨髓瘤為1068.2mg/24h,P=0.017,差異有統(tǒng)計(jì)學(xué)意義。3.單克隆免疫球蛋白血癥患者平均血色素為101.7(80.8-117.2)g/L,血肌酐為74.0(57.8-115.5)μmol/L,骨髓漿細(xì)胞含量為2.5(0.5-6.0)%,原幼漿細(xì)胞比例為0(0-5.5)%,行骨骼影像檢查的5例患者均無(wú)骨質(zhì)疏松、骨質(zhì)破壞表現(xiàn);多發(fā)性骨髓瘤患者平均血色素為76.7(65.2-90.4)g/L,血肌酐為97.0(75.5-222)μmol/L,漿細(xì)胞含量為31.25(16.5-50.0)%,原幼漿細(xì)胞比例為27.3(13.0-45.9)%,有107例(52%)符合骨髓瘤骨質(zhì)疏松伴破壞特點(diǎn)。以上指標(biāo)均具有統(tǒng)計(jì)學(xué)意義。4.有2例單克隆免疫球蛋白血癥患者行腎臟穿刺病理活檢術(shù),病理類(lèi)型分別是輕微病變性腎小球腎炎、膜性腎病;有5例多發(fā)性骨髓瘤患者行腎臟穿刺病理活檢術(shù),其中有3例病理類(lèi)型是輕微病變性腎小球腎炎伴不同程度腎小管間質(zhì)損傷,1例為局灶節(jié)段性腎小球硬化癥伴小管間質(zhì)重度損傷,1例為淀粉樣變性腎病。5.定期隨訪的6例單克隆免疫球蛋白血癥患者,4例規(guī)律化療的患者在末次隨訪時(shí)腎功能穩(wěn)定,2例未化療患者末次隨訪時(shí)腎功能較初診進(jìn)展。6.二分類(lèi)非條件Logistic回歸分析示男性、血紅蛋白、血清鈣、原幼漿細(xì)胞比例、輕鏈類(lèi)型均是多發(fā)性骨髓瘤腎病的獨(dú)立危險(xiǎn)因素。7.治療多發(fā)性骨髓瘤伴腎功能不全的兩組方案(含硼替佐米方案、傳統(tǒng)方案)對(duì)腎功能恢復(fù)率比較無(wú)差異。結(jié)論:1.單克隆免疫球蛋白血癥患者起病年齡較多發(fā)性骨髓瘤患者年輕。2.多發(fā)性骨髓瘤患者貧血較單克隆免疫球蛋白血癥患者嚴(yán)重。3.多發(fā)性骨髓瘤患者的血肌酐值較單克隆免疫球蛋白血癥高,內(nèi)生肌酐清除率較低。4.男性、貧血、血清鈣、原幼漿細(xì)胞比例、輕鏈類(lèi)型均是多發(fā)性骨髓瘤合并腎功能不全的危險(xiǎn)因素。
[Abstract]:Objective: to investigate the difference of clinical indexes in patients with monoclonal immunoglobulinemia (monoclonal gammopathy of undeter mined significant aneus) and multiple myeloma (multiple myeloma), to guide the early diagnosis of multiple myeloma and to analyze the risk factors and early prevention of multiple myeloma with renal insufficiency. Methods: 14 patients with monoclonal immunoglobulinemia and 225 patients with multiple myeloma were selected from the first affiliated Hospital of Guangxi Medical University from 2012 to 2016. The clinical and pathological features were compared. The risk factors and renal outcomes of multiple myeloma patients with renal insufficiency were analyzed retrospectively. The result is 1: 1. The percentage of male patients with monoclonal immunoglobulinemia was 57.1 and that with multiple myeloma was 61.8. The mean age of multiple myeloma was (54.5 鹵6.79) years old and (60.84 鹵9.34) years old respectively. The first clinical symptoms were anemia, bone pain, edema (28.57%), bone pain (59.11%), anemia (16.89%) .2. There was no difference in the positive rate of urinary protein and occult blood between the two groups, the median of 24 hours urine protein in patients with monoclonal immunoglobulinemia was 362.95 mg / 24 h, and that in multiple myeloma was 1068.2 mg / 24 h, the difference was statistically significant. The mean hemoglobin level was 101.7 (80.8-117.2) g / L, serum creatinine was 74.0 (57.8-115.5) 渭 mol / L, bone marrow plasmacyte content was 2.5 (0.5-6.0), and the ratio of protoplasmic cells was 0 (0-5.5). The mean hemoglobin was 76.7 (65.2-90.4) g / L, serum creatinine was 97.0 (75.5-222) 渭 mol / L, plasma cell content was 31.25 (16.5-50.0), plasma cell ratio was 27.3 (13.0-45.9) in patients with multiple myeloma, 107 cases (52%) were in accordance with the characteristics of osteoporosis associated with destruction of myeloma. The above indexes have statistical significance. Two patients with monoclonal immunoglobulinemia underwent renal biopsy, the pathological types were mild pathological glomerulonephritis and membranous nephropathy, and 5 patients with multiple myeloma underwent renal biopsy. Among them, 3 cases were mild pathological glomerulonephritis with different degree of renal tubulointerstitial injury. One case was focal segmental glomerulosclerosis with tubulointerstitial severe injury and one case was amyloidosis nephropathy. The renal function of 6 patients with monoclonal immunoglobulinemia and 4 patients with regular chemotherapy were stable at the last follow-up. The renal function of 2 patients without chemotherapy at the last follow-up was more advanced than that of the first visit. Non-conditional logistic regression analysis showed that male, hemoglobin, serum calcium, ratio of plasma cells and light chain type were all independent risk factors of multiple myeloma nephropathy. There was no difference in the recovery rate of renal function between the two groups (including boron tezomil regimen, traditional regimen) in the treatment of multiple myeloma with renal insufficiency. Conclusion 1. The onset age of patients with monoclonal immunoglobulinemia was younger than that of patients with multiple myeloma. Anemia in patients with multiple myeloma was more severe than that in patients with monoclonal immunoglobulinemia. The serum creatinine level of multiple myeloma patients was higher than that of monoclonal immunoglobulinemia, and the clearance rate of endogenous creatinine was lower than that of monoclonal immunoglobulinemia. Men, anemia, serum calcium, ratio of plasma cells, light chain type were risk factors of multiple myeloma complicated with renal insufficiency.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R733.3;R55

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