Clinical Analysis Of Multiple Myeloma With Renal Insufficiency

Objective: The clinical characteristics and laboratory examination results of multiple myeloma patients were analyzed,and the independent risk factors of renal dysfunction in MM patients were analyzed,so as to improve the understanding of MM renal damage,guide clinical treatment to reduce renal damage,and improve the survival period and quality of life of MM patients.Methods:The clinical data of 146 MM patients in the Second Hospital of Hebei Medical University from January 2016 to December 2019 were analyzed retrospectively.The clinical characteristics and laboratory test results of these patients were analyzed.Results:1.The median age of 146 patients with multiple myeloma was 60 years old(32-83 years old),and the ratio of male and female was 1.56:1.According to whether the serum creatinine of MM patients was less than 177 mmom / L,if the serum creatinine was less than 177 mmol / L,the group with normal renal function,if the serum creatinine was more than 177 mmol / L,the group with incomplete renal function.There was no significant difference in gender and age between mm group and normal renal function group(P > 0.050).The proportion of abnormal plasma cells,LDH,blood calcium,leukocyte count,neutrophil percentage and β2-microglobulin(β2-MG)level in the patients with renal insufficiency were higher than those in the patients with normal renal function;the hemoglobin level and the percentage of lymphocytic cells were lower than those in the patients with normal renal function.According to binary logistic regression analysis,we found that hemoglobin,blood calcium,blood β2-mg and LDH were independent risk factors for renal dysfunction in MM patients(P<0.050).2.87.9% of the patients with serum free light chain(s FLC)≥ 500 mg / L and 44.9% of the patients with normal renal function were in the group of renal insufficiency.Through the statistical analysis of the fish results of 146 MM patients,it was found that the incidence of 1q21 gene amplification and P53 gene deletion was higher in the group with renal insufficiency than that in the group with normal renal function,and the difference between the two groups was statistically significant(P < 0.050).Among the 124 mm subtypes,53 were Ig G(42.7%),27 were Ig A(21.8%),29 were light chain(23.4%),11 were Ig D(8.9%),and 4 were other types(3.2%).The proportion of Ig G type was the highest in mm group with normal renal function(50.0%),and the proportion of light chain type was the highest in mm group with incomplete renal function(41.2%).The analysis showed that the probability of Ig G type with renal function was lower than that of other types,and the probability of light chain type with renal function was higher than that of other types.According to the D-S staging standard,the proportion of patients in stage III is the highest,up to 82.2%,which indicates that patients with myeloma usually suffer from disease concealment,the disease staging is often later when they are hospitalized,and the tumor load is high.According to ISS stage and riss stage,we found that the proportion of stage III patients in renal insufficiency group was significantly higher than that in normal renal function group,87% vs 27.8%(ISS stage),54.3% vs 23.1%(riss stage),and P < 0.050,indicating that the long-term prognosis of MM patients with renal insufficiency was worse.In MM patients with renal insufficiency,hemoglobin,corrected blood calcium value and LDH level at the initial diagnosis could not affect the recovery of renal function after treatment,while patients with low β 2-microglobulin at the initial diagnosis were more likely to recover renal function after treatment,and patients with hemoglobin,LDH and β 2-microglobulin were more likely to recover renal function after treatment.Conclusions:1.The expression levels of hemoglobin,blood calcium,β2-MG and LDH can be regarded as independent risk factors of mm with renal dysfunction.2.MM with renal insufficiency usually has 1q21 gene amplification and P53 gene deletion.3.Patients with MM subtype of light chain type are more likely to have renal insufficiency.4.MM patients with renal insufficiency have the characteristics of more advanced course,higher tumor load and poor long-term prognosis.