胸腔病例（三三八）　多發性骨髓瘤

10.6666/ClinMed.2017.80.1.078

楊善堯；洪緯欣；周昆達；張西川

多發性骨髓瘤(multiple myeloma)

臨床醫學月刊

80卷1期（2017 / 07 / 28）

414 - 420

繁體中文

多發性骨髓瘤(multiple myeloma)為一種漿細胞(plasma cell)的惡性腫瘤，其特色是會不正常的分泌大量的單株抗體(monoclonal antibody)。常見的臨床表現為骨頭疼痛(bone pain)或是骨骼的溶解性病灶(osteolytic lesion)，血液或是尿液存在大量單株抗體，不明原因的貧血(anemia)，腎功能受損(renal failure)，高血鈣(hypercalcemia)。在影像學的表現方面，常常可以在胸部平面影像攝影發現肋骨的病灶，或是在肱骨近端發現不明原因的溶骨性變化。以血液學的觀點，當發現病人有不明原因的貧血、腎功能受損，再加上血液中球蛋白上升超過白蛋白(albumin/globulin reverse)時，宜將多發性骨髓瘤納入鑑別診斷。影像學如果在長骨發現溶骨性病變，或是脊椎椎體有不明原因的壓迫性骨折(compression fracture)變化，要考慮多發性骨髓瘤或是實質性的漿細胞瘤的可能性。

1. (1973).Proposed guidelines for protocol studies. I. Introduction. II. Plasma cell myeloma. 3. Chronic lymphocytic leukemia. IV. Chronic granulocytic leukemia.Cancer Chemother Rep,4,141-173.
2. Bergsagel, DE,Pruzanski, W(1975).Treatment of plasma cell myeloma with cytotoxic agents.Arch Intern Med,135,172-176.
3. Blade, J,Fernandez-Llama, P,Bosch, F(1998).Renal failure in multiple myeloma: presenting features and predictors of outcome in 94 patients from a single institution.Arch Intern Med,158,1889-1893.
4. Bourguet, CC,Logue, EE(1993).Antigenic stimulation and multiple myeloma. A prospective study.Cancer,72,2148-2154.
5. DeFronzo, RA,Cooke, CR,Wright, JR,Humphrey, RL(1978).Renal function in patients with multiple myeloma.Medicine,57,151-166.
6. Gharagozloo, S,Khoshnoodi, J,Shokri, F(2001).Hepatitis C virus infection in patients with essential mixed cryoglobulinemia, multiple myeloma and chronic lymphocytic leukemia.Pathol Oncol Res,7,135-139.
7. Goedert, JJ(2000).The epidemiology of acquired immunodeficiency syndrome malignancies.Semin Oncol,27,390-401.
8. Goldstein, BD(1990).Is exposure to benzene a cause of human multiple myeloma?.Ann N Y Acad Sci,609,225-230.
9. Howe, HL,Wingo, PA,Thun, MJ(2001).Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends.J Natl Cancer Inst,93,824-842.
10. Huang, SY,Yao, M,Tang, JL(2007).Epidemiology of multiple myeloma in Taiwan: increasing incidence for the past 25 years and higher prevalence of extramedullary myeloma in patients younger than 55 years.Cancer,110,896-905.
11. Ichimaru, M,Ishimaru, T,Mikami, M,Matsunaga, M(1982).Multiple myeloma among atomic bomb survivors in Hiroshima and Nagasaki, 1950-76: relationship to radiation dose absorbed by marrow.J Natl Cancer Inst,69,323-328.
12. Kapadia, SB(1980).Multiple myeloma: a clinicopathologic study of 62 consecutively autopsied cases.Medicine,59,380-392.
13. Knudsen, LM,Hjorth, M,Hippe, E(2000).Renal failure in multiple myeloma: reversibility and impact on the prognosis. Nordic Myeloma Study Group.Eur J Haematol,65,175-181.
14. Kyle, RA,Gertz, MA,Witzig, TE(2003).Review of 1027 patients with newly diagnosed multiple myeloma.Mayo Clin Proc,78,21-33.
15. Lackner, H(1973).Hemostatic abnormalities associated with dysproteinemias.Semin Hematol,10,125-133.
16. McArthur, JR,Athens, JW,Wintrobe, MM,Cartwright, GE(1970).Melphalan and myeloma. Experience with a low-dose continuous regimen.Ann Intern Med,72,665-670.
17. Perri, RT,Hebbel, RP,Oken, MM(1981).Influence of treatment and response status on infection risk in multiple myeloma.Am J Med,71,935-940.
18. Rajkumar, SV(2016).Myeloma today: Disease definitions and treatment advances.Am J Hematol,91,90-100.
19. Rajkumar, SV,Dimopoulos, MA,Palumbo, A(2014).International myeloma working group updated criteria for the diagnosis of multiple myeloma.Lancet Oncol,15,e538-e548.
20. Savage, DG,Lindenbaum, J,Garrett, TJ(1982).Biphasic pattern of bacterial infection in multiple myeloma.Ann Intern Med,96,47-50.
21. William, H(2012).Learning radiology: recognizing the basics.Philadelphia:Elsevier.

1. 洪翠蓮,王韋淯(2019)。以胸痛表現之多發性骨髓瘤病例報告。台灣專科護理師學刊，6(1)，61-68。