骨髓上清液Dickkopf1水平在多发性骨髓瘤骨病中的临床研究

Bone marrow plasma concentrations of Dickkopf1 in patients with multiple myeloma

目的：研究多发性骨髓瘤（MM）患者骨髓上清液Dickkopf1（DKK1）水平及其与骨髓瘤分期、溶骨性病变的关系,探讨DKK1在多发性骨髓瘤骨病中的临床作用。方法：采用双抗体夹心酶标免疫分析法（ELISA）检测80例初诊MM患者、10例意义未明的单克隆球蛋白血症（MGUS）患者及20例对照组骨髓上清液DKK1水平。结果：骨髓上清液DKK1水平：MM组患者与MGUS组患者相比明显增高（9.3588±7.9441）ng/ml vs（1.7620±0.7529）ng/ml（P=0.001）;而MGUS组患者与对照组相比无明显变化（1.7620±0.7529）ng/ml vs（1.2491±0.6990）ng/ml（P〉0.05）。DKK1水平与骨髓瘤分期（Durie and Salmon分期）相关：期和期MM患者骨髓上清液DKK1水平明显高于期患者（10.3471±8.0169）ng/ml vs（2.4410±0.6583）ng/ml（P=0.002）;期MM患者与MGUS患者骨髓上清液DKK1水平无统计学显著差异（P〉0.05）。有溶骨性病变的MM患者骨髓上清液DKK1水平明显高于没有溶骨性病变的患者（11.2272±7.9753）ng/ml vs（2.4348±0.6634）ng/ml（P〈0.001）;而且DKK1水平还与骨损害的病灶数相关,0、1-3、〉3分别为（2.4348±0.6634）ng/ml、（4.9845±0.5852）ng/ml、（15.3342±7.9187）ng/ml（P〈0.001）。结论：MM患者DKK1水平明显高于MGUS患者及对照组;而且DKK1水平与骨髓瘤分期及溶骨性病变密切相关,能反映溶骨性病变的程度和范围。

Objective： To detect bone marrow plasma concentrations of Dickkopf1 （DKK1） in patients with multiple myeloma（MM） and to investigate its clinical significance. Methods： Bone marrow plasma DKK1 levels were quantified in 80 newly diagnosed MM patients, 10 monoclonal gammopathy of undetermined significance （MGUS） patients and 20 control subjects by ELISA, using a monoclonal anti-DKK1 antibody. Results： Bone marrow plasma DKK1 was elevated in MM as compared with MGUS[（9. 3588±7. 9441）ng/ml vs （1. 7620±0. 7529）ng/ml,P=0. 001]. There was no difference between MGUS patients and control subjects [（1. 7620±0. 7529）ng/ml vs （1. 2491!0. 6990）ng/ml,P〉0.05]. Bone marrow plasma DKK1 levels were correlated with myeloma Durie and Salmon stages [（2. 4410±0. 6583）ng/ml of stage 1 vs （10. 3471±8. 0169） ng/ml of stage Ⅱ / Ⅲ ,P=0. 002]. There was no difference between MM patients in stage I and MGUS patients （P〉0.05）. Myeloma patients without lytic lesions in conventional radiography had significantly lower DKK1 levels than patients with lytic bone disease [（2. 4348±0. 6634）ng/ ml vs 11. 2272 ± 7. 9753） ng/ml, P 〈 0. 001]. Bone marrow plasma DKK1 levels were correlated with the number of bone lesions,0 vs 1-3 vs 〉3 lesions. （2. 4348±0. 6634）ng/ml, （4. 9845± 0. 5852） ng/ml, （15. 3342 ± 7. 9187） ng/ml （P 〈 0. 001 ）. Conclusions ： Myeloma patients have increased bone marrow plasma DKK1 as compared with patients with MGUS and control subjects. Bone marrow plasma concentrations of DKK1 have close relationship with myeloma stage and lytic bone disease.