多发性骨髓瘤患者TNF-α和β_2-m联检的临床应用价值探讨

Clinical Value of Combined Determination of Plasma TNF-α and β_2-m Levels in Patients with Multiple Myeloma (MM)

目的:探讨多发性骨髓瘤患者血浆肿瘤坏死因子(TNF-α)、β2-微球蛋白(β2-m)联检的临床应用价值。方法:本院38例经血液病诊断标准确诊的多发性骨髓瘤(MM)患者,采用放射免疫分析测定其TNF-α和β2-m水平并进行分析,同时选取30名体检健康者作为对照。结果:①初诊MM患者(14例)及复发患者(16例)的TNF-α和β2-m水平均显著高于平稳期MM患者和对照组,差异有统计学意义(P<0.01)。②Ⅲ期MM患者血浆TNF-α和β2-m水平均显著高于Ⅱ期患者,Ⅱ期患者又显著高于Ⅰ期患者,差异均有统计学意义(P<0.01);Ⅲb期MM患者血浆TNF-α水平显著高于Ⅲa期,差异有统计学意义(P<0.01),而β2-m水平无统计学差异(P>0.05);Ⅱb期MM患者的β2-m水平显著高于Ⅱa,差异有统计学意义(P<0.01),而TNF-α水平无统计学差异(P>0.05)。结论:TNF-α和β2-m联检是MM临床分期、预后及疗效判断的有效指标,能指导临床开展有效的诊疗工作。

Objective To study the clinical significance of determination of plasma levels of TNF-α and β2-m in patients with multiple myeloma （MM）. Methods Plasma levels of TNF -α and β2 - m were determined with RIA in ①14 patients with newly diagnosed MM ② 16MM patients in relapse ③8 MM patients in remission and 30 controls. Results ①The plasma levels of TNF-α and β2-m in the newly diagnosed MM patients and MM patients in relapse were significantly higher than those in MM patients in remission and controls （ P 〈 0. 01）.②As a whole, the plasma TNF-α and β2-m continuously increased from stage Ⅰ patients through stage Ⅲ with significant differences between those in consecutive stages. ③ Detailed analysis revealed that the TNF -α levels in patients of stage Ⅲb （ n = 9） were significantly higher than those in patients of stage In a （ n = 9） but β2- m levels in these two groups of patients were not much different. On the other hand,β2- m levels in patients of stage Ⅱb （ n = 6） were significantly higher than those in patients of stage Ⅱa （ n = 6） while the TNF - α levels were not much different. Conclusion Combined determination of plasma levels of TNF -α and β2- m might be helpful for clinical stage classification in patients with multiple myeloma.