多发性骨髓瘤预后因素筛选及分期比较

Screening of Prognostic Factors and Comparing of Staging Systems of Multiple Myeloma

本研究旨在了解多发性骨髓瘤(MM)患者临床及实验室指标,寻找MM潜在预后因素,比较不同分期标准对疾病的分级情况。应用Kaplan-Meier法计算MM患者中位生存时间,Log-Rank法比较患者生存曲线。通过单变量及多变量分析评估MM患者潜在预后因素。对DS、ISS分期进行双变量相关分析。结果表明,MM患者中位生存时间42.7个月。影响MM患者生存的危险因素包括:Hb、Plt、Alb水平减低,血清LDH、Cr、CRP、β2-MG水平升高及骨髓中浆细胞数量增加,其中仅Hb水平对MM具有独立预后的预测价值。DS与ISS分期显著相关。DS分期中仅Ⅰ与Ⅲ期患者存在显著生存差异,而ISS分期中临床各期患者均存在显著生存差异。结论:Hb、Plt、Alb、LDH、Cr、CRP、β2-MG、骨髓中浆细胞数量对评估MM患者预后有一定临床价值。ISS分期标准可较好区分不同临床分期的MM患者。

This study was aimed to investigate the clinical features and laboratory data of 56 patients with multiple myeloma（MM）, find the potential prognostic factors and compare Dude Salmon staging system with International Staging System for patients classification. The median survival time was calculated by the Kaplan Meier, and survival curves were compared using the Log-Rank test. Potential prognostic factors were evaluated by univadate and multivariate analyses. Bivariate correlation of Dude Salmon staging system with International Staging System were analyzed. The results showed that the median survival time of the patients was 42.7 months, Prognostic factors identified as adversely affecting survival included low levels of hemoglobin, platelet, serum albumin, high levels of lactate dehydrogenase, creatinine, C-reactive, serum β2-microglobulin and high proportion of plasma cells in bone marrow. Among them, only hemoglobin level had independent prognostic value in MM. Durie Salmon staging system significantly correlated with International Staging System. In DS staging system, significant survival differences were found between patiems in stages Ⅰ and Ⅲ but statistically significant survival differences were observed among the all three stages in International Staging System. It is concluded that hemoglobin, platelet, serum albumin, lactate dehydrogenase, creatinine, C- reactive, β2-microglobulin and the number of plasma cells in bone marrow have clinical value for evatuating the prognosis of MM patients. International Staging System can significantly distinguish three clinical stages of MM patients.