【摘要】 目的 了解多发性骨髓瘤（MM）合并新型冠状病毒感染（COVID-19）的情况以及COVID-19患者的临床特征及转归。方法 通过查询病例资料和电话随访，回顾性调研了2022年8月—2023年1月就诊于苏州弘慈血液病医院的MM患者在国内新型冠状病毒（新冠病毒）流行高峰期间COVID-19的发生率，重点收集了27例MM合并COVID-19住院患者的临床表现、实验室指标及预后信息，分析其临床特征。结果 共调研116例MM患者，中位年龄69(38,86)岁，87例（75.0%）患者在流行高峰期间感染了新冠病毒：轻型12例（13.8%）、中型49例（56.3%）、重型20例（23.0%）、危重型6例（6.9%），合并COVID-19患者的死亡率为4.6%(4/87)。住院的27例患者中，男性16例（59.3%）。MM合并COVID-19初发临床表现主要为咳嗽26例（96.3%）、乏力20例（74.1%）、胸闷17例（63.1%）、咽痛17例（63.1%）、发热11例（40.7%）和头痛6例（22.2%）。27例患者合并的COVID-19均为中-危重型。感染新冠病毒后MM患者的白细胞和淋巴细胞计数均明显下降，而IL-6、CRP和D-二聚体则明显升高（P<0.05）。重/危重型较中型患者的淋巴细胞及血Na+水平下降更为明显；而D-二聚体、IL-6、LDH及CRP则升高（P<0.05）。MM合并COVID-19后患者的病毒抗体转阳中位天数为14(11, 19)d，其中IgM抗体滴度中位数为3.25(2.06, 4.69)S/CO,IgG抗体滴度中位数为6.41(2.06, 9.50)S/CO。27例患者中新冠病毒抗原/核酸转阴的中位天数为22(16, 30)d。25例（92.6%）好转出院，中位住院天数为20 (11, 33)d。结论 MM合并COVID-19较2020年死亡率明显下降，但仍易进展为重型/危重型，病毒清除慢。更多还原

【Abstract】 Objective To understand the incidence, clinical features, and outcomes of COVID-19 in patients with multiple myeloma(MM). Methods The data of patients were collected by searching the hospital database and telephone follow-up to retrospectively investigate the incidence of COVID-19 in MM patients who visited Soochow Hopes Hematology Hospital from August 2022 to January 2023 during the peak period of COVID-19 in China. The data for analysis included clinical manifestations,laboratory test results, and outcomes, especially the data of 27 patients complicated COVID-19 pneumonia. Results A total of 116 MM patients were identified. The median age of these patients was 69 years old(range: 38-86). Overall, 87(75.0%) of the patients were complicated with COVID-19 during the epidemic peak, including mild cases(12, 13.8%), moderate cases(49, 56.3%),severe cases(20, 23.0%), and critical cases(6, 6.9%). The mortality rate was 4.6%(4/87) for the patients complicated with COVID-19. Overall, 27 patients were admitted to hospital, including 16 males(59.3%). The initial symptoms of COVID-19 in MM patients were cough in 26 cases(96.3%), fatigue in 20 cases(74.1%), chest tightness in 17 cases(63.1%),pharyngalgia in 17 cases(63.1%), fever in 11 cases(40.7%), and headache in 6 cases(22.2%). All the 27 hospitalized patients had moderate to critical disease. COVID-19 was associated with significantly decreased levels of white blood cells and lymphocytes and significantly increased levels of IL-6, C-reactive protein(CRP) and D-dimer(P < 0.05) in MM patients. The severe/critical patients showed significantly lower levels of lymphocyte count and serum Na+ but significantly increased levels of D-dimer, IL-6, lactate dehydrogenase(LDH), and CRP compared to other patients(P < 0.05). The median(P25, P75) time to positive conversion of antiSARS-Co V-2 antibody was 14(11, 19) days after infection in MM patients. The median titer of Ig M antibody was 3.25(2.06, 4.69) S/CO, and the median titer of Ig G antibody was 6.41(2.06, 9.50) S/CO. The median time from infection to negative conversion of novel coronavirus antigen/nucleic acid was 22(16, 30) days in the 27 hospitalized patients. Overall, 25 of the 27 patients(92.6%) recovered from COVID-19. The median hospital stay was 20(11, 33) days. Conclusions The mortality rate of COVID-19 in MM patients was significantly lower than that in 2020. However, COVID-19 may readily progress to severe/critical condition in MM patients, associated with slow clearance of the virus.更多还原