Dimopoulos M A, Papadimitriou C, Sakarellou N, Athanassiades P
Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece.
Baillieres Clin Haematol. 1995 Dec;8(4):845-52. doi: 10.1016/s0950-3536(05)80263-x.
The clinical spectrum of MM is variable. Infiltration of bone and bone marrow by malignant plasma cells results in severe osteopenia, lytic lesions, pathological fractures and anaemia. Occasionally, significant numbers of plasma cells circulate in the bloodstream. Hypercalcaemia and Bence Jones proteinuria are the main reasons for renal impairment, but amyloidosis and monoclonal immunoglobulin deposition should also be considered. Neurological impairment is most often due to spinal cord pressure by an extradural plasma cell tumour. In some patients, symptoms and signs of peripheral neuropathy may be present. Amyloidosis complicates the course of a minority of patients with MM and further impairs the performance of affected patients. Circulating monoclonal protein may increase serum viscosity, impair the function of platelets and coagulation factors, and behave as a cryoglobulin. The levels of uninvolved immunoglobulins are usually decreased, rendering patients susceptible to various bacterial infections. One or more of these complications provides a clue for the diagnosis, forms the basis for defining prognosis and must be managed expeditiously and concurrently, with the institution of specific treatment for the myeloma.
多发性骨髓瘤（MM）的临床谱具有多样性。恶性浆细胞浸润骨骼和骨髓会导致严重骨质减少、溶骨性病变、病理性骨折和贫血。偶尔，大量浆细胞会在血液中循环。高钙血症和本-周蛋白尿是肾功能损害的主要原因，但也应考虑淀粉样变性和单克隆免疫球蛋白沉积。神经功能损害最常见的原因是硬膜外浆细胞瘤压迫脊髓。在一些患者中，可能会出现周围神经病变的症状和体征。淀粉样变性使少数MM患者的病程复杂化，并进一步损害受累患者的身体状况。循环中的单克隆蛋白可能会增加血清粘度，损害血小板和凝血因子的功能，并表现为冷球蛋白。未受累免疫球蛋白的水平通常会降低，使患者易受各种细菌感染。这些并发症中的一种或多种为诊断提供线索，构成定义预后的基础，并且必须迅速并同时进行处理，同时开展针对骨髓瘤的特异性治疗。
