外周血淋巴细胞绝对值与老年多发性骨髓瘤患者临床病理特征及预后的关系

Correlations between peripheral absolute lymphocyte count and clinicopathological characteristics of the elderly patients with multiple myeloma and its prognosis

目的 探讨外周血淋巴细胞绝对值（ALC）与老年初发多发性骨髓瘤（MM）患者临床病理特征及预后的关系.方法 选取南京医科大学附属无锡人民医院2007年1月1日至2015年12月31日收治的老年MM患者57例,将患者分为ALC≥1.3 × 109/L组（n=24）和ALC＜ 1.3×109/L组（n=33）,记录其ALC及各项临床指标,采用χ2检验、秩和检验、Kaplan-Meier分析、Log-rank检验及Cox多因素分析进行统计学分析,分析外周血ALC与MM患者临床病理特征的关系,并分析其对患者疗效及预后的影响.结果 老年MM患者外周血ALC与其血红蛋白含量有关（χ2=6.195,P=0.009）,与患者性别、年龄、Durie-Salmon分期、国际分期系统分期、肌酐含量、乳酸脱氢酶含量、白蛋白含量、钙离子浓度、体能状态、诊断分型均无关（均P＞0.05）.ALC≥1.3×109/L组与ALC＜ 1.3×109/L组患者疗效差异无统计学意义（Z =0.464,P=0.642）.单因素分析结果显示,年龄（RR=2.843,95％ CI为1.385～5.835,P =0.004）、性别（RR=2.092,95％ CI为1.034 ～4.231,P=0.040）、ALC（RR=3.562,95％ CI为1.539 ～8.244,P=0.003）、血红蛋白含量（RR =3.583,95％ CI为1.087 ～ 11.811,P=0.036）、乳酸脱氢酶含量（RR =3.192,95％ CI为1.580 ～6.452,P=0.001）及疗效（RR=5.202,95％ CI为1.184 ～22.864,P =0.029）与患者预后有关.多因素分析结果显示年龄（RR=2.672,95％ CI为1.235 ～5.782,P=0.013）和ALC（RR =2.613,95％ CI为1.092 ～6.250,P=0.031）是影响MM患者生存的独立预后因素.Kaplan-Meier生存分析显示,ALC≥1.3×109/L组患者的中位总生存期显著长于ALC＜ 1.3 × 109/L组（69个月∶24个月;χ2=10.171,P=0.001）.结论 老年MM患者外周血ALC与患者血红蛋白含量有关,ALC是老年初发MM患者的独立预后因素,对于MM的预后分层有临床价值.

Objective To investigate the correlations between peripheral absolute lymphocyte count （ALC） and clinicopathological characteristics of newly diagnosed elderly patients with multiple myeloma （MM）and its prognosis.Methods A total of 57 elderly patients with MM were selected in Wuxi People＇s Hospital Affiliated to Nanjing Medical University from January 1,2007 to December 31,2015.The patients were grouped as ALC ≥ 1.3 × 109/L （n =24） and ALC 〈 1.3 × 109/L （n =33）.The ALC and clinical characteristics of the patients were collected.The chi-square test,rank sum test,Cox regression analysis,Kaplan-Meier analysis and Log-rank test were used to analyze the correlation of ALC with clinicopathological characteristics,curative effect and prognosis of elderly patients with MM.Results The peripheral ALC of elderly MM patients was related to hemoglobin content （χ2 =6.915,P =0.009）,but it was not related to the sex,age,DurieSalmon stage,international staging system stage,creatinine content,lactate dehydrogenase content,albumin content,concentration of Ca2 ＋,performance status and classification （all P 〉 0.05）.There was no significant difference in efficacy between ALC ≥ 1.3 × 109/L group and ALC 〈 1.3 × 109/L group （Z =0.464,P =0.642）.In univariate analysis,age （RR =2.843,95 % CI：1.385-5.835,P =0.004）,sex （RR =2.092,95% CI：1.034-4.231,P =0.040）,ALC （RR =3.562,95% CI：1.539-8.244,P =0.003）,hemoglobin content （RR =3.583,95% CI：1.087-11.811,P =0.036）,lactate dehydrogenase content （RR =3.192,95% CI：1.580-6.452,P =0.001） and curative effect （RR =5.202,95% CI：1.184-22.864,P =0.029）were related to the prognosis of patients.Multivariate analysis results revealed that age （RR =2.672,95% CI：1.235-5.782,P =0.013） and ALC （RR =2.613,95 % CI：1.092-6.250,P =0.031） were independent predictive factors for patients with MM.Kaplan-Meier analysis indicated that the median overall survival of ALC ≥1.3 × 109/L group was significantly longer than that of ALC 〈 1.3 × 109/L group （69 months vs.24 months;χ2 =10.171,P =0.001）.Conclusion The peripheral ALC in elderly patients with MM is related to hemoglobin content.ALC is an independent prognostic factor for the elderly patients with newly diagnosed MM,and has clinical value for the prognosis of MM.