Huang Heyu, Li Huijun, Li Dengju
aDepartment of Hematology bClinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
Blood Coagul Fibrinolysis. 2015 Jul;26(5):555-9. doi: 10.1097/MBC.0000000000000296.
Abnormalities in haemostasis are often detected in patients with multiple myeloma and the fundamental factors that lead to these abnormities are worthy of exploration. The objective of this study was to investigate bleeding diathesis and coagulopathy in different multiple myeloma types or stages and assess how paraprotein concentration contributes to differences in these conditions. Haemostasis screening tests and serum monoclonal protein (M protein) concentration were retrospectively analysed in 101 patients newly diagnosed with multiple myeloma from January 2012 to April 2014. No significant differences were found between bleeding diathesis and types or International Staging System (ISS) stages of multiple myeloma; however, prolonged thrombin time (TT) was found in most of patients (77.7%) and was positively related to light-chain concentration (P ≤ 0.01). Prolonged prothrombin time (PT) was more obvious in IgA and IgG-type multiple myeloma than in the light-chain type (P ≤ 0.01). With increased clinical staging, PT remarkably increased (P ≤ 0.01). M protein concentration was significantly higher in patients with prolonged PT than in those with normal PT (P ≤ 0.01). The D-dimer mean was significantly higher than normal (>0.5 μg/ml) (P ≤ 0.01). Fibrinogen was negatively related to M protein levels (P ≤ 0.01); however, there was no correlation between activated partial thromboplastin time (APTT) and multiple myeloma stages or types, M protein levels and serum light-chain concentration (P ≥ 0.05). Patients with light-chain type multiple myeloma were more likely to have prolonged TT than patients with other types. M protein levels had an obvious effect on PT. Prolonged PT was more common in IgA and IgG-type multiple myeloma. Abnormal haemostasis test results are not always accompanied by clinically apparent haemostatic complications.
多发性骨髓瘤患者常出现止血异常，导致这些异常的根本因素值得探究。本研究的目的是调查不同类型或分期的多发性骨髓瘤患者的出血倾向和凝血病，并评估副蛋白浓度如何导致这些情况的差异。对2012年1月至2014年4月新诊断的101例多发性骨髓瘤患者的止血筛查试验和血清单克隆蛋白（M蛋白）浓度进行回顾性分析。多发性骨髓瘤患者的出血倾向与类型或国际分期系统（ISS）分期之间未发现显著差异；然而，大多数患者（77.7%）出现凝血酶时间（TT）延长，且与轻链浓度呈正相关（P≤0.01）。IgA和IgG型多发性骨髓瘤患者的凝血酶原时间（PT）延长比轻链型更明显（P≤0.01）。随着临床分期增加，PT显著升高（P≤0.01）。PT延长患者的M蛋白浓度显著高于PT正常患者（P≤0.01）。D - 二聚体平均值显著高于正常水平（>0.5μg/ml）（P≤0.01）。纤维蛋白原与M蛋白水平呈负相关（P≤0.01）；然而，活化部分凝血活酶时间（APTT）与多发性骨髓瘤分期或类型、M蛋白水平和血清轻链浓度之间无相关性（P≥0.05）。轻链型多发性骨髓瘤患者比其他类型患者更易出现TT延长。M蛋白水平对PT有明显影响。PT延长在IgA和IgG型多发性骨髓瘤中更常见。止血试验结果异常并不总是伴有临床上明显的止血并发症。
