【摘要】 目的分析多发性骨髓瘤(Multiplemyeloma，MM)伴肾功能不全(renalfailure，RF)患者的临床特征，探索发生RF的危险因素。方法对MM伴发RF的91例患者进行回顾性分析，并与同期住院的165例肾功能正常MM对照研究，统计学方法采用卡方检验和logistic回归分析。结果91例中48(52．7％)例以肾损害为首发症状，其中30(62．5％)例延误诊治。与对照组比较，高血钙、高血尿酸、贫血、血M蛋白增高、溶骨性损害发生率均明显增加(P<0．05)。预后较对照组有明显差别：3月内病死率为26／91对14／165(P<0．0001)．3月～1年病死率为14／91对12／165(P<0．05)，生存期超过1年的为18／91对95／165(P<0．0001)。回归分析显示发生RF的危险因素包括肾毒性药物的应用史、中重度贫血、血M蛋白增高、男性、高钙血症。结论肾功能不全是MM的早期并发症，容易引起误诊，这类患者确诊MM时病情往往较重，并发症多，预后差。对贫血重、伴有高血钙、曾用肾毒性药物的MM患者，应警惕RF的发生。更多还原

【Abstract】 Objective: To study clinical features of the patients with multiple myeloma (MM) accompanied by renal insu?ciency and investigate the related risk factors of renal impairment. Methods: A control study of clinical characteristics was performed between 91 patients with renal insu?ciency due to MM and 165 patients with normal renal function in MM during the same period. The data were statistically analyzed by chi-square test and logistic regression analysis. Results: Renal insu?ciency was the initial presentation in 48 (52.7%) of the 91 patients, and 30 (62.5%) of the 48 patients were misdiagnosed. The prognosis of group with renal insu?ciency was signi?cantly poorer than that of group with normal renal function: mortality in 3 months, 3 months–1 year was 26/91 vs 14/165 (P <0.0001), 14/91 vs 12/165 (P <0.05) respectively, and patients survived ≥1 year was 18/91 vs 95/165 (P <0.0001). The incidence of hypercalcemia, hyperuricemic, severe anemia, high serum M-protein concentration and lytic bone lesions were signi?cantly higher in renal insu?ciency group than those in control group (P <0.05). Logistic regression analysis identi?ed 5 risk factors of renal impairment, including, severe anemia (Exp(β)=13.819, P <0.0001), use of nephrotoxic drugs (Exp(β)=6.217, P =0.001), high serum M-protein concentration (Exp(β)=5.026, P =0.001), male (Exp(β)=3.745, P =0.006), and hypercalcemia (Exp(β)=3.472, P =0.006), but age, serum density of uric acid, type of serum M-protein, and Bence Jones proteinuria were not signi?cantly associated with renal insu?ciency. Conclusion: Renal insu?ciency was a common early complication of MM, which often resulted in misdiagnosis. The status of these patients tended to be very bad, with many other complications, when MM was diagnosed, so their prognosis was poor. The occurrence of renal insu?ciency in patients with MM and hypercalcemia, severe anemia, high serum M-protein concentration, especially use of nephrotoxic drugs should be alert.更多还原