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目的观察血浆置换-血液净化治疗多发性骨髓瘤(MM)并发肾衰竭患者的疗效。方法 MM并发急性肾衰竭患者34例,其中男性19例,女性15例;年龄42～75岁,平均年龄54岁。采用HA130灌流器(珠海丽珠医用公司),对其进行血浆置换-血液净化治疗。每3天行1次血浆置换-血液净化治疗,3次为1疗程。统计分析治疗前后的尿素氮、血肌酐(SCr)、每日尿量。结果共进行96次血浆置换-血液净化。治疗有效者22例,其中包括肾功能逆转17例,5例发展为慢性尿毒症,无效者12例(其中死亡患者2例,主动出院者3例)。尿素氮、SCr治疗后均显著下降;治疗前后比较,差异有显著统计学意义(P<0.001)。每日尿量从(924.32±543.26)mL下降到(331.24±321.01)mL;治疗前后比较,差异有显著统计学意义(P<0.001)。中重度贫血29例中缓解24例(82.8%);差异有显著统计学意义(P<0.001)。免疫球蛋白IgG型患者治疗后17例有效。结论血浆置换-血液净化治疗MM并发肾衰竭可以延长患者生存时间,促进急性肾衰竭完全康复,提高患者生活质量。
Objective To observe the effect of plasma exchange and blood purification on patients with multiple myeloma (MM) complicated with renal failure. Methods 34 patients with acute renal failure complicated by MM, of which 19 were males and 15 females; aged 42 to 75 years, mean age 54 years. Using HA130 cartridge (Zhuhai Livzon Medical Corporation), its plasma exchange - blood purification treatment. 1 plasma exchange every 3 days - blood purification treatment, 3 times for a course of treatment. Statistical analysis before and after treatment of urea nitrogen, serum creatinine (SCr), daily urine output. Results A total of 96 plasma exchange-blood purifications were performed. Twenty-two patients were treated effectively, including 17 cases of renal function reversal, 5 cases of chronic uremia, 12 cases of ineffectiveness (including 2 deaths and 3 active discharges). Both urea nitrogen and SCr decreased significantly after treatment. There was significant difference between before and after treatment (P <0.001). The daily urine output decreased from (924.32 ± 543.26) mL to (331.24 ± 321.01) mL. The difference was statistically significant before and after treatment (P <0.001). Among 29 cases of moderate to severe anemia, 24 cases (82.8%) were relieved; the difference was statistically significant (P <0.001). Immunoglobulin IgG type 17 patients after treatment effective. Conclusion Plasma exchange - blood purification in patients with MM complicated with renal failure can prolong the survival time of patients, promote complete recovery of acute renal failure, and improve the quality of life of patients.