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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。
Objective To analyze the clinical features of patients with multiple myeloma (MM) with renal insufficiency (RF) and explore the risk factors for RF. Methods A retrospective analysis of 91 patients with MM associated with RF was performed. The study was compared with 165 patients with normal renal function during the same period. The statistical method was analyzed by chi-square test and logistic regression analysis. Results Among the 91 patients (48.8%), 48 cases (52.7%) had renal damage as the first symptom, of which 30 cases (62.5%) were delayed in diagnosis and treatment. Compared with the control group, hypercalcemia, hyperuricemia, anemia, increased blood M protein and osteolytic lesions were significantly increased (P<0.05). The prognosis was significantly different from that of the control group: the mortality rate within 3 months was 26/91 vs. 14/165 (P<0.0001). The mortality rate from March to 1 year was 14/91 vs. 12/165 (P<0.05), and the survival period was over 1 year with 18/91 vs. 95/165 (P<0.0001). Regression analysis showed that risk factors for RF included the application history of nephrotoxic drugs, moderate and severe anemia, elevated blood M protein, male, and hypercalcemia. Conclusions Renal insufficiency is an early complication of MM, and it is easy to cause misdiagnosis. Such patients often have heavier disease, more complications and poor prognosis. Patients with severe anaemia, hypercalcemia, and previously nephrotoxic drugs should be alert to the occurrence of RF.