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目的探讨多发性骨髓瘤(MM)并发急性肾衰竭(ARF)的原因,提高早期诊断率。方法回顾性分析2000—2007年在我院住院的MM患者163例的临床资料,其中MM并发ARF36例(ARF组),肾功能正常组127例。病例均符合MM诊断标准和(或)ARF诊断标准。结果ARF组诊断时MM分期均为Ⅲ期,而肾功能正常组患者有69.3%处于Ⅲ期,两者比较差异有统计学意义(P<0.01)。ARF组和肾功能正常组M蛋白分型比较,差异有统计学意义(P<0.05),ARF组以轻链型为主。ARF组尿本周蛋白阳性率(69.4%)与对照组(31.5%)比较,差异有统计学意义(P<0.01)。在AFR患者中,λ型轻链多见。Logistic回归分析显示,发生ARF的独立危险因素有5个,分别为轻链蛋白沉积、高血钙、肾毒性药物、血清M蛋白阳性和高血尿酸血症。36例中除4例自动放弃治疗外,5例肾功能完全恢复;7例缓解,脱离透析;12例发展为不可逆肾衰竭,行维持性血液透析治疗;8例死亡,其中死于感染性休克3例,多器官功能衰竭5例。结论ARF是MM的严重并发症,病死率高。针对MM患者并发ARF的独立危险因素,给予适当的避免措施,可改善MM合并ARF的预后。
Objective To investigate the causes of multiple myeloma (MM) complicated with acute renal failure (ARF) and to improve the early diagnosis rate. Methods The clinical data of 163 patients with MM who were hospitalized in our hospital from 2000 to 2007 were retrospectively analyzed. Among them, 36 cases of MM complicated with ARF (ARF group) and 127 cases of normal renal function group. All cases met the MM diagnostic criteria and / or ARF diagnostic criteria. Results The MM stage of ARF group was all stage Ⅲ, while 69.3% of the patients with normal renal function group were in stage Ⅲ, the difference was statistically significant (P <0.01). There was a significant difference in M protein type between ARF group and normal renal function group (P <0.05), while light chain type was the main factor in ARF group. Urinary weekly protein positive rate (69.4%) in ARF group was significantly higher than that in control group (31.5%) (P <0.01). In AFR patients, λ light chain more common. Logistic regression analysis showed that there were 5 independent risk factors of ARF, including light chain protein deposition, hypercalcemia, nephrotoxic drugs, serum M protein positive and hyperuricemia. Among the 36 cases, 4 cases were given up for treatment, 5 cases had complete recovery of renal function, 7 cases were relieved and were separated from dialysis, 12 cases developed irreversible renal failure and maintained hemodialysis treatment. 8 cases died of septic shock 3 cases, multiple organ failure in 5 cases. Conclusion ARF is a serious complication of MM with high case fatality rate. MM patients with ARF independent risk factors, given appropriate avoidance measures, can improve the prognosis of MM with ARF.