Analysis Of Clinical Features Of MGUS,MGRS And MM

Objective To analyze and compare the clinical characteristics of patients with monoclonal gammopathy of undetermined significance(MGUS),monoclonal gammopathy of renal significance(MGRS),multiple myeloma(MM)and MGUS complicated with other renal diseases(MGUS~+),to explore the clinical predictive factors of MGRS,and to find the risk factors of MM patients with renal insufficiency to guide early clinical diagnosis and treatment.Methods 147 patients with monoclonal gammopathy(MG)treated in Hebei General Hospital from January 2017 to December 2020 were selected.Patients with smoldering multiple myeloma(SMM),waldenstrom macroglobulinaemia(WM),chronic lymphocytic leukaemia(CLL)and other malignant tumors were excluded.The patients were divided into MGUS group(n=28),MGRS group(n=11),MM group(n=87)and MGUS~+group(n=21).The clinical characteristics of four kinds of patients were compared,and the clinical predictive factors of MGRS and the risk factors of MM with renal insufficiency were analyzed.Results 1 The mean age of onset was(56.25±6.76)years,(58.7±7.8)years,(63.23±9.25)years and(54.33±9.27)years in the 4 groups of MGUS,MGRS,MM and MGUS~+.For the first clinical symptoms,there was no specific clinical manifestation in MGUS group;MGRS showed edema of both lower extremities;bone pain was the most common in MM(44%),followed by anemia(35%);edema,hematuria or proteinuria were more common in MGUS~+group(57%,19%).2 As for target organ damage,compared with MM group,the content of bone marrow plasmacytes and the proportion of protoplasmacytes in MGUS+MGUS~+and MGRS groups were lower(P<0.001),Hb was higher in MGUS,MGRS and MGUS~+groups(P<0.001),and corrected calcium and Scr were lower in MGUS,MGRS and MGUS~+groups(P<0.01).Among the four groups,EPI-e GFR was lower in MM group(P<0.001).There were differences in the positive rate of urinary protein,the positive rate of microscopic hematuria and its severity among MGRS,MM and MGUS~+groups.The quantity of 24-hour urinary protein in MGRS and MRUS~+group was higher than that in MM group,especially in MGRS group(P<0.001).3 The monoclonal immunoglobulins of MGUS+MGUS~+group,MGRS group and MM group were mainly Ig G,followed by Ig A.There was significant difference in the positive rate ofκandλlight chain among MGUS+MGUS~+,MGRS and MM patients(P<0.023).The positive rates ofκandλlight chain in MGUS+MGUS~+and MGRS were 61.2%and90.0%,respectively,while those in MM patients were similar(50.6%VS 49.3%).4 Light chain amyloidosis(AMY)was more common in MGRS patients(81.8%),followed by light chain deposition disease(LCDD),and MN was more common in non-MGRS patients(76.2%).5 Binary Logistic regression analysis showed that urinary protein≥6.425g/d was a independent predictor of MGRS.6 Binary Logistic regression analysis showed that male and lower hemoglobin level were independent risk factors for MM complicated with renal insufficiency.Conclusion 1 Among the patients with MG,the age of onset in MM group is older,the anemia is more serious,Scr and UA are higher and e GFR is lower.2 Light chain AMY was more common in patients with MGRS,followed by LCDD.MN was more common in non-MGRS patients.3 Urinary protein≥6.425g/d is a independent predictor of MGRS.4 Both male and lower hemoglobin level are the independent risk factors of MM complicated with renal insufficiency.Figure 8;Table 17;Reference 122...