Clinical Study Of Multiple Myeloma With Blood Stasis Syndrome

Objective: To observe and analyze the proportion of multiple myeloma(MM)patients suffering from blood stasis syndrome and the related factors of blood stasis syndrome,as to summarize the clinical features of MM blood stasis syndrome,and to provide a theoretical and objective basis for the diagnosis and treatment of MM in traditional Chinese medicine.Methods: Collecting medical records of the MM patients who meet the selection criteria at the faculty of hematology of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2018 to January 2020.To diagnose and quantificat blood stasis syndrome according to the "Practical Diagnostic Criteria of Blood Stasis Syndrome" [1],and analyse the correlation between blood stasis syndrome and/or the degree of blood stasis syndrome and the patient's age,gender,ISS stage,M protein classification,ECOG score,PN grade,laboratory values,hypercoagulable state,and TCM syndrome type.Data is processed using SPSS 23.0software.Results: 1.In the included 96 patients,56 patients meet the criteria of blood stasis syndrome,accounting for 58.3% of the total number of patients.Among MM patients with blood stasis syndrome,the blood stasis syndrome scores are from 2 points to 11 points.Patients with a score of 2 are the most common,accounting for 37.5% of the total number of MM patients with blood stasis syndrome.The number of patients in other groups is close.2.Dividing patients into blood stasis group and non blood stasis syndrome group,the two groups have no statistically significant differences in gender(X2 = 0.940,P =0.332),age(t = 0.602,P = 0.549)and M protein classification(Fisher's exact test,P =0.462).3.The proportion of newly diagnosed patients with blood stasis syndrome is lower than the proportion of previous diagnosed patients,which has statistically significant difference(X2 = 11.156,P = 0.001).The proportion of patients with blood stasis syndrome with different disease courses is statistically significant(X2 = 17.491,P<0.001).The proportion of patients with blood stasis syndrome with a course of one year or less is lower than those with a course of the disease over one year.4.The proportion of blood stasis syndrome in MM patients with different ISS stages is statistically significant(X2 = 10.200,P = 0.006).The proportion of blood stasis syndrome patients in stage ISS-III is significantly higher than that of ISS-I and ISS-II patients.5.The proportion of patients with blood stasis syndrome is different among patients with different ECOG scores,and the proportion of patients with blood stasis syndrome in the ECOG score 3 group(91.3%)is significantly higher than in the ECOG score 0 group(33.3%)and the ECOG score 1 group(42.9%)(P value both lower than 0.001).6.Patients with different peripheral neuropathy(PN)levels have different proportions of blood stasis syndrome patients.The proportion of blood stasis syndrome patients with grade 3 sensory neuropathy(86.4%)is significantly higher than that of grade 0(43.5%)and grade 1(41.7%)patients,and the difference is statistically significant(P= 0.003,0.001).The proportion of blood stasis syndrome patients with motor nerve grade 3(86.4%)and grade 2(80.0%)is significantly higher than that of grade 0(34.9%),and the difference is statistically significant(P <0.001,P = 0.003).The proportion of blood stasis syndrome patients with neuralgia 3 grade(93.3%)and grade 1(80.0%)is significantly greater than that of grade 0(38.2%),and the difference is statistically significant(P <0.001,P = 0.007).7.The relationship between the blood stasis score of MM patients and course(R =0.470,P <0.001),ISS stage(R = 0.252,P = 0.013),ECOG score(R = 0.542,P<0.001),PN grade(sensory nerve,motor neuropathy and neuralgia grade's P values are all less than 0.001)is positive linear.8.People with or without blood stasis syndrome have no statistically significant difference in PT(U = 977.5,P = 0.288),APTT(U = 972.0,P = 0.271),FIB(U =987.5,P = 0.325),AT3(U = 919.5,P = 0.136),CHOL(U = 1053.0,P = 0.619),TG (U = 1043.5,P = 0.570),HDL(U = 973.5,P = 0.276).The two groups have statistically significant differences in TT(U = 737.0,P = 0.004),D-D2(U = 387.5,P<0.001)and VDL(U = 835.0,P = 0.034).The average level of D-D2 value in patients with blood stasis syndrome exceeds the upper limit of normal standard values.9.According to the”Laboratory Criteria of Hypercoagulability” [2]developed by Zheng Yang and Chen Xinyi,a total of 9 patients achieved hypercoagulability,all had a blood stasis score of 5-11,45% of all the patients with a blood stasis score of 5-11 in this study.10.The proportion of MM blood stasis syndrome patients is statistically significant different in various TCM syndromes(X2 = 12.918,P = 0.005).Patients with sputum and congestion obstruction syndrome are more likely to have blood stasis syndrome.Conclusions: 1.Blood stasis syndrome is a common syndrome in multiple myeloma patients,and patients with sputum and congestion obstruction syndrome are more likely to have blood stasis syndrome.2.The formation of blood stasis syndrome in multiple myeloma patients is associated with the course of the disease.Patients with longer course are more likely to develop blood stasis syndrome than those with shorter course.3.Among multiple myeloma patients,those with a higher ISS stage are more likely to develop blood stasis syndrome and have higher blood stasis score.4.Among multiple myeloma patients,patients with higher ECOG are more likely to develop blood stasis syndrome.Besides,the patients with a higher ECOG score generally have more severe degree of blood stasis.5.As for multiple myeloma peripheral neuropathy patients,patients with higher level are more likely to develop blood stasis syndrome and have higher blood stasis score,so it is speculated that adding the medicine of invigorating the circulation of blood properly may be beneficial in treating peripheral neuropathy.6.The average level of D-D2 value in patients with blood stasis syndrome is higher than that of patients without blood stasis syndrome and exceeds the upper limit of normal standard values.7.Blood stasis syndrome and hypercoagulability are related but not completely equivalent.Besides,patients with severe blood stasis syndrome are more likely to have hypercoagulability.