NF-κB受体活化因子配基和骨保护素的表达与脊柱浆细胞骨髓瘤的关系

Expression of receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) and their relationship with spinal plasma cell myeloma bone disease

目的探讨脊柱浆细胞骨髓瘤(plasma cell myeloma,PCM)中NF-κB受体活化因子配基(receptor activator of nuclear factorκB ligand,RANKL)和骨保护素(osteoprotegerin,OPG)的表达与脊柱PCM相关骨病的关系。方法应用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结(SP)法检测63例脊柱PCM及10例正常骨髓中RANKL和OPG的表达,并结合骨髓瘤患者临床影像学资料对骨髓瘤骨病(myeloma bone disease,MBD)进行分级。行χ2检验、Kruskal-Wallis秩和检验或log-rank检验分析相关数据。结果脊柱PCM中RANKL表达明显高于正常骨髓,差异有统计学意义(P<0.01);OPG表达明显低于正常骨髓,差异有统计学意义(P<0.01)。RANKL的表达与MBD分级相关(P<0.05),骨病分级越高,RANKL的表达越高。骨病分级与脊柱PCM预后有相关性,其平均生存期为Ⅲ级少于Ⅱ级少于Ⅰ级。结论脊柱PCM中存在RANKL/OPG系统的平衡失调。RANKL作为破骨细胞刺激因子可能在PCM的溶骨性病变和骨质破坏中起着重要的作用。骨病分级对脊柱PCM的预后判断具有一定的临床意义。

Objective To investigate the expression of receptor activator of nuclear factor κB ligand（RANKL） and osteoprotegerin（OPG） in spinal plasma cell myeloma（PCM） and to analyze their relationship with spinal PCM bone disease.Methods The expression of RANKL and OPG was detected in 63 spinal PCM cases and 10 normal bone marrow cases by streptavidin-perosidase immunohistochemical staining.Myeloma bone disease（MBD） was classified by clinical imaging data.All the datas were analyzed by χ2 test,Kruskal-Wallis test or log-rank test.Results The positive expression rate of RANKL was higher in spinal PCM cases than in normal bone marrow,and the difference was statistically significant（P〈0.01）.OPG expressed lower in spinal PCMs than in the normal bone marrow,and the difference was statistically significant（P〈0.01）.RANKL was also correlated with bone disease ranking（P〈0.05）.The higher the bone disease degree was,the higher the expression rate of RANKL was.Bone disease ranking was related with overall survival time.The mean survival time of bone disease level in Grade Ⅱ was longer than that in Grade Ⅲ and shorter than that in GradeⅠ.Conclusion The balance of RANKL/OPG system is disturbed in PCM.RANKL may play a crucial role in osteolytic lesions and bone destruction.Bone disease ranking can be a prognostic factor of spinal PCM.