摘要
目的 研究多发性骨髓瘤合并肾功能不全的临床特点厦肾功能可逆性的相关因素和生存相关因素。方法 回顾性分析1999—01—2003—12北京协和医院收治的91例初治多发性骨髓瘤及其中38例多发性骨髓瘤合并肾功能不全患者的临床资料。结果 91例初治多发性骨髓瘤中有38例（41．8％）合并肾功能不全。合并肾功能不全的患者病程进展更快，贫血更严重，血乳酸脱氢酶（LDH）和β2-微球蛋白（β2-MG）质量浓度更高，以及尿蛋白量更多，同时对化疗的反应更差及生存时间更短。其中34．2％的患者肾功能不全是可逆的，血肌酐和LDH是肾功能可逆的独立预测因素。肾功能可逆患者的生存时间与肾功能正常患者的生存时间比较差异无显著性意义。Cox生存多因素分析发现肾功能可逆性（B=l，294，EXP（B）=3．647，P=0．001）是与生存惟一相关的因素。结论 肾功能不全是多发性骨髓癌常见并发症，相当一部分患者的肾功能可以恢复正常，血肌酐水平和LDH水平是肾功能可逆的重要因素，肾功能可逆性是独立的生存预后因素。
Objective To analyze the clinical features, the factors associated with renal function recovery and survival in patients with multiple myeloma and renal failure. Methods From Jan. 1999 to Dec. 2003 medical records of patients from our hospital with multiple myeloma and renal failure diagnosed were reviewed. Results Renal failure was observed in 38 （41.7 % ） of 91 patients with multiple myeloma. Patients with renal failure had more advanced disease, higher serum lactate dehydrogenase （LDH） level and beta - 2 - microglobulin （ 132 - MG） level, lower response rate to chemotherapy and shorter survival than the others. Renal function recovery was observed in 34. 2 % patients. Logistic regression multivariate analysis showed that serum creatinine level, serum LDH level were associated with renal function recovery. Patients who recovered from renal function had a median survival of 26 months vs 5 months for those with nonreversible renal failure. Cox regression multivariate analysis found that renal function recovery （ B = 1. 294, EXP （B） = 3. 647, P = 0. 001 ） was correlated with survival in patients with multiple myeloma and renal failure. Conclusion Renal failure is a common complication of multiple myeloma. Patients with renal function recovery have longer survival time. Factors related to renal function recovery are degree of renal failure and serum LDH level. Renal function recovery is the only independent factor associated with survival.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2006年第3期341-343,共3页
Chinese Journal of Practical Internal Medicine
