多发性骨髓瘤患者骨髓骨硬化蛋白表达及其临床意义分析

Expression and clinical significance of bone marrow sclerostin in patients with multiple myeloma

目的探讨多发性骨髓瘤（MM）患者骨髓上清液骨硬化蛋白（sclerostin）的表达水平及其临床意义。方法采用酶联免疫吸附试验法定量检测sclerostin的水平，逆转录-聚合酶链反应（RT—PCR）检测骨髓单核细胞（BMMNC）sclerostin基因的表达。结果MM组sclerostin水平为（O．54±O．21）pg／mL，明显高于对照组（O．31±0．06）pg／mL，差异有统计学意义（t=5．67，P〈0．01）；复发难治组sclerostin水平为（O．65±0．17）pg／mL，明显高于对照组及初诊组（O．47±0．21）pg／mL，差异有统计学意义（t=8．44、3．27，P〈0．01），RT-PCR也证实了部分MM患者的BMMNC能表达sclerostin基因；MM组sclerostin水平与碱性磷酸酶（ALP）呈负相关（r=-0．379，P=0．005），与校正血钙、骨质损害评分、血清β2-微球蛋白、M蛋白的比例、临床ISS分期呈正相关；中位随访时间29（6～65）个月，低sclerostin组中位生存期为48（6～65）个月，高sclerostin组中位生存期为24（6～52）个月，二者比较差异有统计学意义（x2=12．74，P〈0．01）。结论骨髓sclerostin水平可反映MM患者骨质破坏、成骨受抑程度及机体瘤负荷水平，并能在一定程度反映患者的中位生存期。

Objective To investigate the bone marrow supernatant expression of sclerostin in the patients with multiple myeloma （MM） and to clarify its clinical signification. Methods The sclerostin level was quantified by using ELISA,and the gene expression of sclerostin was determined by RT-PCR. Results The sclerostin level was （0. 54±0.21）pg/mL in the MM group,which was sig- nificantly higher than （0.31±0.06）pg/mL in the control group （t=5.67,P〈0.01）. The sclerostin level was （0.65±0. 17） pg/ mL in the recurrent and refractory MM group,which was significantly higher than （0.47±0.21） pg/mL in the control group and the newly diagnosed group （t = 8. 44,3.27, P〈0.01）, RT-PCR verified that the BMMNC of most patients expressed sclerostin gene. The expression of sclerostin in the MM group was negatively correlated with alkaline phosphatase（ALP） （r= -0. 379, P= 0. 005）,and positively related with the correction blood calcium, bone loss points, serum β2-micro globulin（132-GM）, proportion of serum M protein and clinical International Staging System（ISS） stages. The median follow-up periods were 29 （6-65） months, the low sclerostin group had the median survival period of 48 （6-65） months and the high sclerostin group had the median survival pe- riod of 24（6--52） months,the difference between them had statistical significance （X2 =12.74,P〈0.01）. Conclusion Its level may reflect the bone destruction,osteogenesis inhibition degree and myeloma burden,and reflect the median survival period of MM patients to some extent.