多发性骨髓瘤合并胸腔积液的临床分析

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摘要目的总结并分析多发性骨髓瘤（MM）合并胸腔积液的临床特点。方法回顾2000年1月~2016年12月于北京大学第一医院确诊的MM患者，记录其人口学、MM分期及分型、实验室检查等资料进行统计分析。结果本研究共纳入348例MM患者，合并胸腔积液者130例（37.4%），其中骨髓瘤性胸腔积液（MPE）9例（2.6%）。合并胸腔积液组总蛋白、白蛋白、钙、补体C3含量低于无胸腔积液组，乳酸脱氢酶（LDH）含量高于无胸腔积液组（P < 0.05）。多元回归分析显示低C3血症（OR=0.282，95%CI 0.096~0.830，校正P < 0.01）和低水平血清总蛋白（OR=0.979，95%CI 0.966~0.993，校正P < 0.01）是MM合并胸腔积液的独立危险因素；MPE组LDH和腺苷脱氨酶（ADA）含量高于非MPE组（P < 0.05）。结论胸腔积液是MM的并发症之一，低C3血症和低水平血清总蛋白是MM合并胸腔积液的独立危险因素，胸腔积液高LDH和ADA水平提示出现MPE的风险增高。有关MM合并胸腔积液、特别是MPE的发病机制尚待进一步研究。

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	许慧莹周伟炜林连君刘新民

关键词 ：多发性骨髓瘤, 胸腔积液, 骨髓瘤性胸腔积液, 发病机制

Abstract：Objective To analyze the clinical characteristics of multiple myeloma (MM) with pleural effusion. Methods This was a retrospective study. Patients diagnosed of MM from January 2000 to December 2016 in Peking University First Hospital were included. Demographic, clinical and laboratory tests data were collected prospectively and analyzed statistically. Results The overall rate of pleural effusion was 37.4%(130/348) in MM patients, and myelomatous pleural effusion(MPE) rate showed to be 2.6%(9/348). The levels of total protein (TP), albumin, calcium, and complement 3 (C3) in the pleural effusion group were lower than those in the non-pleural effusion group, and the LDH level in the pleural effusion group was higher than that in the non-pleural effusion group (P < 0.05). Hypocomplementemia of C3(OR=0.282, 95%CI 0.096-0.830, P < 0.01) and lower level of TP(OR=0.979, 95%CI 0.966-0.993, P < 0.01) were independent risk factors of pleural effusion production according to multiple Logisitic regression. The levels of LDH and adenosine deaminase (ADA) were higher level in the MPE group than those in the non-MPE group (P < 0.05). Conclusion Pleural effusion is one of the complications of MM, in which MPE is rare. Hypocomplementemia of C3 and lower level of TP seem to be independent risk factors of pleural effusion production in MM. High level of LDH and ADA in pleural effusion remind the high risk of MPE. The pathophysiology of pleural effusion, especially MPE in MM needs further research in the future.

Key words： Multiple myeloma Pleural effusion Myelomatous pleural effusion Pathophysiology

基金资助:北京市自然科学基金资助项目（7151011）。

通讯作者: 刘新民（1959.11-），男，教授，博士生导师，主要从事肺癌、肺动脉高压、肺间质疾病、胸膜疾病的研究。

作者简介: 许慧莹（1989.6-），女，北京大学医学部2015级老年内科专业在读博士研究生，主要从事胸膜疾病的研究。

引用本文:

许慧莹周伟炜林连君刘新民. 多发性骨髓瘤合并胸腔积液的临床分析[J]. 中国医药导报, 2017, 14(15): 31-34.
XU Huiying ZHOU Weiwei LIN Lianjun LIU Xinmin. Clinical analysis of multiple myeloma with pleural effusion. 中国医药导报, 2017, 14(15): 31-34.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I15/31

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