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目的了解多发性骨髓瘤(MM)肾损害患者临床特征及其发生的相关因素。方法对经临床、病理明确诊断的MM肾损害患者的临床特征及实验室检查进行统计学分析。结果MM肾损害的发生率为40.9%(18/44),临床症候群以肾功能不全(血肌酐>177 μmol/L)最为常见(77.8%),其次为肾病综合征(16.7%)、无症状尿检异常(5.56%)。血清轻链阳性率为72.2%(13/18),尿中轻链阳性率为77.8%(14/18例),均以λ链为主。骨髓浆细胞数量和尿本周蛋白(BJP)与肾功能损害之间有显著相关关系(P<0.01;P<0.05),贫血及多发性骨损害与肾脏损害有相关关系(P<0.05)。结论MM伴肾损害患者临床症候群以肾功能不全多见,血清与尿液中轻链以λ为主。骨髓浆细胞增殖及尿轻链蛋白产生可能是多发性骨髓瘤肾脏损害的主要原因。
Objective To investigate the clinical characteristics of patients with multiple myeloma (MM) and its related factors. Methods The clinical features and laboratory tests of patients with MM nephropathy diagnosed clinically and pathologically were analyzed statistically. Results The incidence of renal damage in MM was 40.9% (18/44). The most common clinical symptom was renal dysfunction (serum creatinine> 177 μmol / L) (77.8%), followed by nephrotic syndrome (16.7%), asymptomatic Abnormal urinalysis (5.56%). The positive rate of serum light chain was 72.2% (13/18), and the positive rate of light chain in urine was 77.8% (14/18 cases), all of which were dominated by λ chain. There was a significant correlation between the number of bone marrow plasma cells and urinary albumin (BJP) and renal dysfunction (P <0.01; P <0.05), anemia and multiple bone lesions and renal damage (P <0.05). Conclusion The clinical syndromes of MM with renal impairment are more common in patients with renal insufficiency. The light and light chains in serum and urine are mainly λ. Bone marrow plasma cell proliferation and urinary light chain protein production may be the main cause of multiple myeloma kidney damage.