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目的总结多发性骨髓瘤(MM)伴肾损害的临床特征。方法回顾性分析38例MM伴肾损害患者的临床资料。结果MM伴肾损害患者中临床症候群以肾功能不全(血肌酐≥133μmol/L)最常见(84.21%),其次为肾病综合征(10.53%)和无症状性尿蛋白阳性(5.26%);患者贫血发生率高(92.11%);高血压发生率低(18.42%);高钙血症发生率为28.95%,高血钙患者有更严重的肾功能不全、贫血、高球蛋白血症,差异有统计学意义(P<0.05);血清M蛋白阳性率为71.05%;溶骨性病变占68.80%;尿液轻链阳性率为63.16%,以λ轻链为主;尿本-周蛋白阳性率为47.37%;B超显示:左肾(104±9.5)mm、右肾(101±10.2)mm,表明双肾均无显著缩小。结论MM伴肾损害患者临床上以肾功能不全最常见,尿液中以λ轻链为主,同时常伴有严重贫血、高钙血症、血压不高、双肾缩小不显著等特点。
Objective To summarize the clinical features of multiple myeloma (MM) with renal impairment. Methods Retrospective analysis of 38 cases of MM with renal damage in patients with clinical data. Results The most common clinical symptom of renal dysfunction (serum creatinine ≥133μmol / L) was found in MM patients with renal impairment (84.21%), followed by nephrotic syndrome (10.53%) and asymptomatic urinary protein (5.26%), The incidence of anemia was high (92.11%). The incidence of hypertension was low (18.42%). The incidence of hypercalcemia was 28.95%. Patients with hypercalcemia had more severe renal insufficiency, anemia and hypergammaglobulinemia. (P <0.05); The positive rate of serum M protein was 71.05%; The osteolytic lesions accounted for 68.80%; The positive rate of urine light chain was 63.16% Rate was 47.37%; B ultrasound showed: left kidney (104 ± 9.5) mm, right kidney (101 ± 10.2) mm, showed no significant reduction in both kidneys. Conclusion MM with renal damage in patients with renal insufficiency is the most common in the urine to lambda light chain, often accompanied by severe anemia, hypercalcemia, blood pressure is not high, narrowing of the kidneys is not significant and so on.