Department of Internal Medicine, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA.
Thromb Res. 2010 Mar;125(3):216-9. doi: 10.1016/j.thromres.2009.01.004. Epub 2009 Feb 3.
Monoclonal gammopathy of undetermined significance (MGUS) has been proposed to be a risk factor for venous thromboembolic disease (VTE). However, no series published to date has been population-based or included a control group with similar comorbidities to people with MGUS.
PATIENTS/METHODS: We reviewed the records of all the male veterans in a single VA healthcare system with MGUS between January 1, 1996 and December 31, 2005. We compared the rate of VTE in 166 patients with MGUS with the rate of VTE in an age-matched control group of 465 patients who had tested negative for monoclonal gammopathy by serum protein electrophoresis (SPEP).
The VTE rate in the MGUS group was 2.2 per 100 person-years, which was not significantly different from the rate in the control group, 1.4 per 100 person-years (HR 1.38, CI 0.63-3.01, p=0.42). Most VTE events occurred within 4 months of the diagnosis of MGUS. In univariate analysis, albumin level (HR 0.21, CI 0.1-0.41, p<0.001), abnormal leukocyte count (HR 2.53, CI 1.09-5.86, p=0.03), and history of prior VTE (HR 4.41, CI 1.69-11.54, p=0.003) were associated with increased risk of VTE. On multivariate analysis, albumin level and history of prior VTE remained significant, but presence of MGUS was still not significantly associated with VTE risk.
Our results suggest that the increased rate of VTE in people with MGUS may be primarily due to other underlying conditions that led to testing for a monoclonal gammopathy rather than to the monoclonal gammopathy itself.
意义未明的单克隆丙种球蛋白血症（MGUS）已被提出是静脉血栓栓塞疾病（VTE）的一个危险因素。然而，迄今为止发表的没有一个系列是基于人群的，也没有包括一组与 MGUS 患者具有相似合并症的对照组。
患者/方法：我们回顾了 1996 年 1 月 1 日至 2005 年 12 月 31 日期间，在一个单一的退伍军人事务部医疗保健系统中患有 MGUS 的所有男性退伍军人的记录。我们将 166 例 MGUS 患者的 VTE 发生率与通过血清蛋白电泳（SPEP）检测为单克隆丙种球蛋白阴性的 465 例年龄匹配对照组的 VTE 发生率进行了比较。
MGUS 组的 VTE 发生率为每 100 人年 2.2 例，与对照组的每 100 人年 1.4 例无显著差异（HR 1.38，CI 0.63-3.01，p=0.42）。大多数 VTE 事件发生在 MGUS 诊断后的 4 个月内。在单变量分析中，白蛋白水平（HR 0.21，CI 0.1-0.41，p<0.001）、异常白细胞计数（HR 2.53，CI 1.09-5.86，p=0.03）和既往 VTE 病史（HR 4.41，CI 1.69-11.54，p=0.003）与 VTE 风险增加相关。在多变量分析中，白蛋白水平和既往 VTE 病史仍然显著，但 MGUS 的存在与 VTE 风险仍无显著相关性。
我们的结果表明，MGUS 患者 VTE 发生率增加可能主要是由于导致检测单克隆丙种球蛋白的其他潜在疾病，而不是单克隆丙种球蛋白本身。
