Byun Ja Min, Kim Ki Hwan, Choi In Sil, Park Jin Hyun, Kim Jin-Soo, Shin Dong-Yeop, Koh Youngil, Kim Inho, Yoon Sung-Soo, Lim Hyo Jeong
Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Acta Haematol. 2017;138(2):69-76. doi: 10.1159/000477793. Epub 2017 Aug 11.
In many Asian countries battling with the double burden of increasing noninfectious diseases on top of infectious diseases, multiple myeloma (MM) patients presenting with pleural effusion (PE) pose a great diagnostic challenge. Thus, we aimed to analyze the clinical features and practice patterns of such patients. This is a multicenter retrospective study of newly diagnosed MM patients between January 2011 and December 2015. Among 575 MM patients diagnosed during the study period, 80 (13.9%) that were associated with PE were identified and analyzed. The most common cause of PE was parapneumonic (25%), followed by reactive (18.8%). Higher CRP levels and leukocytosis were indicators of parapneumonic PE. There were 7 (8.8%) with myelomatous PE and 2 (2.5%) with tuberculosis. Fifty-six patients underwent additional examinations to determine the exact cause of effusion; 28 patients received computed tomography (CT) of the chest, 5 patients underwent thoracentesis/biopsy, and 23 patients underwent both CT and thoracentesis/biopsy. On the other hand, 24 patients did not undergo additional analyses but were treated empirically. Real-world analyses of practice patterns in MM patients with PE showed the suboptimal use of invasive procedures to determine the exact cause of PE. Since reversible causes and tuberculosis pleurisy are not uncommon, invasive procedures should be actively incorporated as needed.
在许多亚洲国家，除了传染病之外还面临着非传染性疾病不断增加的双重负担，出现胸腔积液（PE）的多发性骨髓瘤（MM）患者带来了巨大的诊断挑战。因此，我们旨在分析此类患者的临床特征和诊疗模式。这是一项对2011年1月至2015年12月期间新诊断的MM患者进行的多中心回顾性研究。在研究期间诊断的575例MM患者中，确定并分析了80例（13.9%）伴有PE的患者。PE最常见的原因是肺炎旁性（25%），其次是反应性（18.8%）。较高的CRP水平和白细胞增多是肺炎旁性PE的指标。有7例（8.8%）为骨髓瘤性PE，2例（2.5%）为结核性。56例患者接受了进一步检查以确定胸腔积液的确切原因；28例患者接受了胸部计算机断层扫描（CT），5例患者接受了胸腔穿刺术/活检，23例患者同时接受了CT和胸腔穿刺术/活检。另一方面，24例患者未进行进一步分析而是接受了经验性治疗。对伴有PE的MM患者诊疗模式的真实世界分析显示，在确定PE的确切原因方面，侵入性检查的使用并不理想。由于可逆性病因和结核性胸膜炎并不罕见，应根据需要积极采用侵入性检查。
