标题：Frequency of hyperviscosity syndrome and consecutive cardiologic and neurologic complications in patients with Waldenström's disease and Iga myeloma
期刊名称：Aktuelnosti iz Neurologije, Psihijatrije i Graničnih Područja
印刷版ISSN：0354-2726
出版年度：2005
卷号：XIII
期号：3-4
页码：24-36
出版社：Clinical Center of Vojvodina
摘要：We analysed frequency of the hyperviscosity syndrome in patients with primary macroglobulinemia (Waldenstrom's disease, WD) and IgA multiple myeloma as well as frequency of cardiovascular and neurological disorders which might be associated with these complications. The analysis included 29 patients with WD and 29 patients with IgA myeloma treated at the Military Medical Academy in Belgrade within the period 1986-2003. Follow-up period was from 1 to 14 years. Blood viscosity was determined in all patients who had the total protein level above normal value (over 85 g/l), that is, in 18 (62.1%) patients with WD and in 23 (79.3%) with IgA myeloma. Viscosity was measured by the routine Ostwald method, by measuring the serum viscosity. Increased blood viscosity was found in 15 (51.7%) patients with WD and in 10 (34.5%) with IgA myeloma. No complete correlation between the paraprotein level and blood viscosity was found in any of the groups. None of the patients with WD had symptoms of hyperviscosity syndrome at the time their diagnoses were established, but in later clinical course (2-6 years after the diagnosis) it occurred in 7 patients (24.1% of those with WD, that is, in 46.7% of patients with increased blood viscosity). After therapy and blood viscosity reduction only 2 (6.9% of all patients from the IgA myeloma group or 20% of all patients from this group with increased blood viscosity) had symptoms of hyperviscosity syndrome. These symptoms only partly subsided in these patients regardless of achieved significant viscosity reduction. This suggests possible effect of other factors upon development of these disorders. In the group of 211 patients with other forms of multiple myeloma (IgG, IgD, IgM, light-chain disease, solitary myeloma), treated within the same period, hyperviscosity syndrome was found in only 2 patients (one IgG and one IgM myeloma) and significant hyperproteinemia (over 120 g/l) was found in both of them. Analysed was importance of blood hyperviscosity, that is, effect of hyprviscosity syndrome during one period of the underlying disease clinical course, upon the total survival rate. It was shown that this did not exert any important effect upon the course in patients with WD in contrast to those with IgA myeloma. In 4 out of 5 patients with hyperviscopsity syndrome associated with WD, previously present cardiomyopthy was aggravated, but only in one patient it than occurred and just in that case further course of the underlying disease was less favorable. Manifestations were in the form of congestive myocardiopathy. Cardiologic changes in patients with IgA myeloma with marked hyperviscosity were with signs of the global heart failure in one and with frequent anginose troubles in the other patient in who after reducing hyperviscosity acute myocardial infarction of the lower right ventricle wall developed later on. In both cases further course of the disease was unfavorable. Neuropathy was manifest at the time of established diagnosis in the small number of patients with IgA myeloma (/14;48,3%). Patients with WD had sensorimotor neuropathy, compressive neuropathy and encephalopathy. During the established hyperviscosity syndrome all these patients with WD had signs of sensorimotor neuropathy, while all patients with IgA myeloma with increased blood viscosity already had some of neuropathy forms.
