目的

探讨超声心动图在多发性骨髓瘤（MM）合并心脏淀粉样变（CA）中的诊断价值。

方法

选取2015年1月至2024年6月于南京鼓楼医院确诊为MM并具有完整超声心动图资料者共93例，其中单纯MM者61例为对照组，MM合并CA者32例为病例组。比较2组患者的超声心动图常规参数及应变参数；采用单因素Logistic回归分析MM合并CA的超声心动图相关参数；采用Pearson分析评价病例组血清脑钠肽（BNP）与超声心动图参数的相关性。

结果

与对照组相比，病例组的超声心动图参数左心房内径（LAD）、左心室室壁厚度、相对室壁厚度（RWT）、E/e'、心尖保留率（ASR）、室间隔应变比值（SAB）及左心室射血分数应变比值（EFSR）均较高，左心室射血分数（LVEF）及左心室整体纵向应变（GLS）较低，差异均具有统计学意义（P均＜0.05）。单因素Logistic回归分析显示，LAD、左心室室壁厚度、RWT、E/e'、LVEF、GLS、ASR、SAB及EFSR是评估MM是否合并CA的相关因素，单因素分析结果有统计学意义（P均＜0.05）。ROC曲线结果显示，RWT、LVEF、GLS、ASR、SAB及EFSR参数预测MM合并CA的ROC曲线下面积分别为0.754、0.709、0.824、0.724、0.661及0.821（P均＜0.05），特异度为82.0% ～ 95.1%，敏感度为50.0%～68.8%，其中GLS与EFSR的预测效能优于其他参数。与对照组相比，病例组血清BNP水平较高（P=0.007）；对照组心电图提示肢体导联低电压和（或）V₁～V₃导联R波递增不良者2例，病例组中15例，差异有统计学意义（P＜0.001）。相关性分析显示，病例组中LVEF与血清BNP呈负相关（P＜0.001），应变参数GLS、ASR、SAB、EFSR均与血清BNP呈正相关（r = 0.666、0.633、0.396、0.609，P均＜0.05）。

结论

超声心动图可以评估MM合并CA的心脏功能受损程度，对预测MM合并CA具有一定的诊断价值，尤其应变参数GLS和EFSR，可以提高对MM合并CA的早期诊断效能，为临床诊疗提供更可靠的依据。

Objective

To preliminarily investigate the diagnostic value of echocardiography in multiple myeloma （MM） combined with cardiac amyloidosis （CA） by analyzing echocardiographic parameters retrospectively， in order to provide a clinical basis for early diagnosis of MM combined with CA.

Methods

A total of 93 patients who were diagnosed with MM from January 2015 to June 2024 at Nanjing Drum Tower Hospital and had complete echocardiographic data were selected， including 61 cases with MM alone （control group） and 32 cases with MM combined with CA （case group）. Routine echocardiographic parameters and echocardiographic strain parameters were compared between the two groups. Echocardiographic parameters of MM combined with CA were assessed using univariate Logistic regression analysis， and the correlation between serum brain natriuretic peptide （BNP） and echocardiographic parameters in the case group was evaluated using Pearson's analysis.

Results

Compared with the control group， the echocardiographic parameters left atrial diameter （LAD）， left ventricular wall thickness， relative ventricular wall thickness （RWT），E/e'， apical sparing ratio （ASR）， septal apical-septal basal ratio （SAB）， and left ventricular ejection fractionto-strain ratio （EFSR） were significantly higher in the case group， and the left ventricular ejection fraction（LVEF） and left ventricular global longitudinal strain （GLS） were significantly lower in the case group （P＜0.05 for all）.Univariate Logistic regression analysis showed that LAD， left ventricular wall thickness， RWT， E/e'，LVEF， GLS， ASR， SAB， and EFSR were factors significantly associated with CA in MM （P＜0.05 for all）.Receiver operating characteristic （ROC） curve analysis showed that the area under the ROC curve values of RWT， LVEF， GLS， ASR SAB， and EFSR parameters for predicting MM combined with CA were 0.754，0.709， 0.824， 0.724， 0.66， and 0.821， respectively （P＜0.05）， their specificity ranged from 82.0% to 95.1%，and their sensitivity ranged from 50.0% to 68.8%， with the predictive efficacy of GLS and EFSR being better than that of other parameters. Compared with the control group， serum BNP level was significantly higher in the case group （P=0.007）. There were two cases of electrocardiograms suggesting low voltage in limb leads and/or poor R-wave increment in leads V₁～V₃ in the control group， and 15 cases in the case group， with a statistically significant difference between the two groups （P＜0.001）. Correlation analysis showed that LVEF was negatively correlated with serum BNP in the case group （P＜0.001）， and the strain parameters GLS， ASR， SAB， and EFSR were positively correlated with serum BNP （r = 0.666， 0.633， 0.396， and 0.609，respectively； P＜0.05 for all）.

Conclusion

Echocardiography can be used to assess the degree of cardiac function impairment in MM combined with CA and has appreciated diagnostic value in predicting this condition， especially the strain parameters GLS and EFSR， which can improve the early diagnostic efficacy of MM combined with CA and provide a more reliable basis for clinical diagnosis and treatment.