Interstitial changes

Statistically significant signs (P <0.05): 1) interstitial changes on radiographs and CT images (p = 0.000001), 2) decrease in PM, during endobronchial LDF <50PE (p = 0.000058), 3) decrease in VC during spirography <80% D (p = 0.025), 4) High level of M-component (IgG> 70 g / l, IgA> 50 g / l) (p = 0.00015), 5) decrease in hemoglobin less 85 g / l (p = 000362), 6) blood creatinine level> 170 μm / l (p = 0.0086). The combination of the above indicators with a high degree of probability may indicate the presence of myelomatous lesions of the bronchopulmonary system. Strengthening and deformation of the pulmonary pattern is explained by the stagnation of blood in small vessels and the development of pneumosclerosis, since due to the increased plasma viscosity, blood flow in the pulmonary capillaries slows down. Violation of microhemocirculation in the vessels The ICC is also explained by the hyperviscosity of the plasma, due to paraproteinemia. A high level of the M-component and a decrease in hemoglobin of less than 85 g / l are observed in patients with stage III myeloma, when there is a large tumor mass and visceral manifestations of the disease. Reduction of VC is a consequence of the defeat of the bronchopulmonary system in patients with MM (Chapter 4). Lymphoid and / or plasma cell infiltration, paraproteinosis and / or amyloidosis were diagnosed in the majority of deceased patients with MM in the presence of CRF in the lungs. In addition, severe bronchopulmonary complications develop in uraemia: uremic pulmonary edema, pneumonitis and metastatic calcification.

Statistically insignificant signs (p> 0.05): 1) the presence of multiple bone destruction on radiographs (p = 0.980), included patients who did not have pulmonary in vivo complete illness was performed. All 2) the presence of visceral lesions of other organs and systems (liver, spleen, etc.) (p = 0.205), 3) decrease in FEV 1
<80% D, during spirography (p = 0.437), 4) significant chest deformity (p = 0.551), 5) difficulty breathing (p = 0.959), 6) serum calcium level> 2.6 µm / l (p = 0.159), 7) daily proteinuria BJ> 4 g per day (p = 0.576). The lack of significant significance of such indicators as difficulty breathing is explained by the fact that the clinical manifestations of myelomatous lung lesions were very rare, only in some patients with uremic pulmonary edema. None of the patients with spirography showed a violation of obstructive type VFL, a decrease in FEV 1 was observed only in patients with a decrease in VOL (a violation of VFL in a mixed type).

The coefficients of classifying functions are given. Classifying functions: group 1 – patients without myelomatosis of the bronchopulmonary system; group 2 – patients with myelomatous lesions of the bronchopulmonary system.

The resulting classification functions can be used to assign a new patient to group 1 or group 2. For this, the values ​​of the indicators received from the newly admitted patient are entered into the classification functions for groups 1 and 2. Then the classification functions are calculated, and The patient belongs to the group for which the calculation gave a greater value.

As an example, here is an extract from the case history No 23145. Patient B. 1951, born The diagnosis “Multiple myeloma, diffuse focal form with PIgG secretion, stage IIIIA” was revealed in 2000. Myelogram contains 70% of plasma cells. On the roentgenogram, multiple destruction in the ribs, skull, spine, pelvic bones. The secretion of serum immunoglobulin G – 90 g / l. Bens-Jones proteinuria, protein – 5000 g / ml. In the clinical analysis of blood, hemoglobin decrease is 90 g / l, ESR acceleration is 60 mm / h. Therapy was carried out according to the MP protocol, after which the “plateau” phase was achieved, which lasted until 2003. In the spring of 2003 – a relapse of the disease. He received treatment according to polychemotherapy protocols at the beginning of the first line, then according to the VAD protocol and VAD-like protocols. In September 2003, chronic renal failure joined. In August 2004, death was ascertained. 
 Data from lifetime instrumental examination

respiratory system: on radiographs – increased pulmonary pattern, emphysema, pneumosclerosis; spirography – VC 82% D, FEV 1 84% D; endobronchial LDF – PM 29 PE, zone lung rheography – MOVr (sum) – 65 ohm / min, MPKr (sum) – 45 ohm / min, Ultrasonic diaphragm scan: TD – 5.7 mm., EDS – 11 mm ., EDF – 29 mm.

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