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以门静脉高压所致消化道出血为首发症状的多发性骨髓瘤1例报告
DOI: 10.3969/j.issn.1001-5256.2021.01.032
作者贡献声明：苏洁、王莹负责拟定写作思路，撰写论文；潘煜修改论文；华瑞指导撰写文章并最后定稿。
Multiple myeloma with gastrointestinal bleeding due to portal hypertension as the initial manifestation: A case report
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Key words:
- Bone Marrow Neoplasms /
- Hypertension, Portal /
- Case Reports
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图 1 全腹CT平扫+三期增强
注：a, 肝脏表面光滑(白色箭头)，各叶段比例协调，肝门、肝裂不宽；b, 门静脉主干增宽(黑色箭头)，门静脉周围可见曲张静脉(白色箭头)，脾大。
表 1 非肝硬化门静脉高压症的病因
肝前性门静脉高压 肝性门静脉高压 肝后性门静脉高压 窦前性 窦性 窦后性 肝外门静脉阻塞(门静脉血栓形成、脾静脉血栓形成、内脏动静脉瘘、脾肿大)，浸润性疾病(淋巴瘤、骨髓增生性疾病)，贮藏性疾病(戈谢病) 发育异常，胆道疾病，门静脉癌性闭塞，肉芽肿性病变，肝门静脉硬化，非肝硬化门静脉纤维化，特发性门静脉高压 窦性纤维化，窦性崩塌，窦性防御，窦性浸润(肥大细胞增多、特发性髓样化生、戈谢病、淀粉样变性)，窦性压缩 静脉闭塞，肝静脉血栓，血管恶性肿瘤肉芽肿性静脉炎，布加综合征 下腔静脉阻塞(血栓形成、肿瘤、尾状叶增大)，缩窄性心包炎，三尖瓣反流，严重右心衰竭，限制性心肌病 
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[1] Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association. Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension (2019 edition)[J]. Chin J Dig Surg, 2019, 18(12): 1087-1093. (in Chinese)中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18 (12): 1087-1093. [2] SANYAL AJ, BOSCH J, BLEI A, et al. Portal hypertension and its complications[J]. Gastroenterology, 2008, 134(6): 1715-1728. DOI: 10.1053/j.gastro.2008.03.007 [3] GONZALEZ-AGUIRRE AJ, LIN O, CHO C, et al. Transjugular liver biopsy in a multiple myeloma patient with hepatomegaly, portal hypertension and "Miliary" liver lesions: A case report[J]. J Gastrointest Dig Syst, 2016, 6(1): 390. http://europepmc.org/abstract/MED/28775913 [4] RAHHAL FE, SCHADE RR, NAYAK A, et al. Hepatic failure caused by plasma cell infiltration in multiple myeloma[J]. World J Gastroenterol, 2009, 15(16): 2038-2040. DOI: 10.3748/wjg.15.2038 [5] MUHAMMAD KHAN M, UR RASHID M, ULLAH W, et al. Rare case of acute on chronic hepatic failure in a patient with multiple myeloma-associated amyloidosis[J]. BMJ Case Rep, 2020, 13(1): e231563. DOI: 10.1136/bcr-2019-231563 [6] D'ALITTO F, SCHERZ A, MARGINI C, et al. Portal hypertension and a stiff liver[J]. Cureus, 2018, 10(6): e2768. http://www.ncbi.nlm.nih.gov/pubmed/30101047 [7] GIRNIUS S, SELDIN DC, SKINNER M, et al. Hepatic response after high-dose melphalan and stem cell transplantation in patients with AL amyloidosis associated liver disease[J]. Haematologica, 2009, 94(7): 1029-1032. DOI: 10.3324/haematol.2008.001925 [8] KUMAR KS, LEFKOWITCH J, RUSSO MW, et al. Successful sequential liver and stem cell transplantation for hepatic failure due to primary AL amyloidosis[J]. Gastroenterology, 2002, 122(7): 2026-2031. http://europepmc.org/abstract/MED/12055607 -
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