外周血细胞计数及其比值对初诊伴非骨相关髓外病变的多发性骨髓瘤患者预后的评估价值

Value of Peripheral Blood Cell Count and Its Ratio in Evaluating Prognosis of Newly Diagnosed Multiple Myeloma Patients with Non-bone-related Extramedullary Diseases

目的探讨外周血淋巴细胞计数(ALC)、单核细胞计数(AMC)、淋巴细胞与单核细胞比值(LMR)、血小板与淋巴细胞比值(PLR)与初诊时伴非骨相关髓外病变(sEMD)的多发性骨髓瘤(MM)患者临床病理特征的相关性以及对疗效和生存的影响。方法收集81例初诊时伴sEMD的MM患者临床病理资料,分别分析外周血ALC、AMC、LMR、PLR与血红蛋白、肌酐水平、乳酸脱氢酶水平、β2微球蛋白水平、治疗疗效、预后生存情况等指标关系。以ALC、AMC、PLR、LMR中位数为界值进行分组。Kaplan-Meier法分析ALC、AMC、PLR、LMR与生存及预后之间的关系;预后多因素分析采用Cox风险回归模型。结果 81例患者ALC、AMC、PLR、LMR中位数分别为1.38×10~9/L、0.48×10~9/L、134.9、3.11,多因素分析结果显示:LMR≤3.11(P=0.021)、PLR≥134.9(P=0.019)、LDH≥247U/L(P=0.041)、Hb≤110 g/L(P=0.004)是初诊伴sEMD的MM患者预后不良的影响因素。结论对于初诊伴sEMD的MM患者,LMR≤3.11、PLR≥134.9、LDH≥247 U/L、Hb≤110 g/L可能是其影响预后不良的独立因素。

Objective To investigate the correlation of peripheral blood lymphocyte count(ALC), monocyte count(AMC), lymphocyte-to-monocyte ratio(LMR), platelet-lymphocyte ratio(PLR) with clinicopathological features of initially-diagnosed multiple myeloma(MM) patients with non-bone-related extramedullary diseases(sEMD), as well as their effect on efficacy and survival. Methods We collected the clinicopathological data of 81 MM patients with sEMD at the initial diagnosis to analyze the relationship of peripheral blood ALC,AMC, LMR, PLR with hemoglobin, creatinine level, lactate dehydrogenase level,β2 microglobulin level,therapeutic efficacy, prognosis survival, etc. The median of ALC, AMC, PLR and LMR were taken as the cutoff value for grouping. Kaplan-Meier method was used to analyze of the relationship of ALC, AMC, PLR,LMR with survival and prognosis. The Cox proportional hazard model was used for multivariate analysis of prognosis. Results The median ALC, AMC, PLR and LMR of the 81 patients were 1.38×10~9/L, 0.48×10~9/L, 134.9 and 3.11, respectively. The multivariate analysis showed that LMR≤3.11(P=0.021), PLR≥134.9(P=0.019), LDH≥247 U/L(P=0.041), and Hb≤110 g/L(P=0.004) were independent predictors of poor prognosis of initially-diagnosed MM patients with sEMD. Conclusion For initially-diagnosed MM patients with sEMD, LMR≤3.11, PLR≥134.9, LDH≥247 U/L and Hb≤110 g/L may be independent factors for the poor prognosis.