初级卫生保健中60岁及以上患者对未确定意义单克隆γ病(MGUS)的管理和监测缺乏认识:简短交流

Zvonimir Bosnić
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摘要

未确定意义单克隆γ病(MGUS)是一种罕见的恶性前克隆浆细胞疾病,其特征是存在单克隆(M)蛋白,骨髓中不到10%的克隆浆细胞,没有多发性骨髓瘤或相关淋巴浆细胞恶性肿瘤[1,2]。它与多发性骨髓瘤或相关恶性疾病的进展率为每年1%或更低相关[3]。尚未准确确定50岁及以上人群中意义不明的单克隆γ病的患病率[4]。在以往的研究中,据报道,在社区就诊的患者中,正常人群血清中单克隆免疫球蛋白的发生率为0.5%至3.6%,通常是MGUS的巧合发现[5-7]。先前的报道预计,在未来30年,被诊断为MGUS的在世个体数量将远远超过100万[8]。因为目前的实践指南不建议在普通人群中进行MGUS的常规筛查,因为缺乏证实的益处和缺乏治疗或预防治疗。在本综述中,我们假设在初级卫生保健中,60岁及以上患者的MGUS管理存在严重困难。摘要
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Lack of Awareness in Managment and Monitoring of Monoclonal Gammopathy of Undetermined Significance (MGUS) in Patients aged 60 years and more in Primary Health Care: Short Communication
Monoclonal gammopathy of undetermined significance (MGUS) presents a rare premalignant clonal plasma cell disorder, characterized by the presence of a monoclonal (M) protein, less than 10% of clonal plasma cells in the bone marrow and absence of multiple myeloma or related lymphoplasmacytic malignancies [1,2]. It is associated with a rate of progression to multiple myeloma or a related malignant condition of 1 percent per year or less [3]. The prevalence of monoclonal gammopathy of undetermined significance among persons 50 years of age or older has not been accurately determined [4]. In previous studies, the frequency of monoclonal immunoglobulins in serum from a normal population has been reported to be 0.5 to 3.6 percent among patients seen in community practice, and usually it was the coincidental finding of MGUS [5-7]. Previous reports expected that the number of living individuals diagnosed with MGUS will be well over a million in next 30 years [8]. Cause current practice guidelines do not recommend routine screening for MGUS in the general population because of the lack of proven benefit and absence of curative or preventive therapy. In this overview, we assume severe difficulities in managment of MGUS in patients aged 60 years and more in primary health care. Abstract
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