多发性骨髓瘤患者血清25-羟基维生素D表达及临床意义

Expression and clinical significance of 25-hydroxy vitamin D in patients with multiple myeloma

目的探究25-羟基维生素D[25-(OH)D]在多发性骨髓瘤(MM)患者血清中的表达及其临床意义。方法选取2016年4月至2018年12月于新疆维吾尔自治区人民医院初次诊断为MM的83例患者,同期选取本院健康体检人员40名为对照组。检测血清中25-(OH)D及β2微球蛋白(β2-MG)、血红蛋白、白蛋白、钙离子、乳酸脱氢酶水平,结合患者骨损伤情况及疾病分期进行比较分析。结果MM患者血清25-(OH)D水平明显低于对照组[(12.4±2.7)μg/L比(21.3±3.2)μg/L],差异有统计学意义(P=0.007)。多发性骨髓瘤骨病患者(62例)25-(OH)D充足率明显低于无骨病患者(21例),其缺乏率和严重缺乏率均明显高于无骨病组[3.2%(2/62)比19.0%(4/21)、40.3%(25/62)比33.3%(7/21)、30.6%(19/62)比9.5%(2/21)],差异均有统计学意义(均P<0.05)。国际分期系统分期Ⅲ期MM患者血清25-(OH)D水平明显低于Ⅰ、Ⅱ期患者[(7.5±2.9)μg/L比(20.2±4.2)、(18.8±3.8)μg/L],差异均有统计学意义(均P<0.05);Ⅰ期与Ⅱ期MM患者之间比较差异无统计学意义(P>0.05)。Durie-Salmon分期Ⅲ期MM患者血清25-(OH)D水平明显低于Ⅰ、Ⅱ期患者[(8.5±2.4)μg/L比(23.8±4.5)、(17.5±3.6)μg/L],且Ⅱ期MM患者明显低于Ⅰ期患者,差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,MM患者血清25-(OH)D水平与血红蛋白水平(r=0.452,P=0.021)、白蛋白水平(r=0.212,P=0.007)呈正相关;与β2-MG水平(r=-0.415,P=0.023)、钙离子水平(r=-1.063,P=0.009)呈负相关。结论血清25-(OH)D在MM患者中表达水平偏低,可能与MM患者的肿瘤负荷及预后相关。

Objective To observe the expression level of 25-hydroxy vitamin D[25-( OH) D]in patients with multiple myeloma( MM) and to explore its clinical significance. Methods From April 2016 to December2018,83 patients with newly diagnosed MM and 40 healthy volunteers were recruited at People’ s Hospital of Xinjiang Uygur Autonomous Region. Serum contents of 25-( OH) D,β2-microglobulin,hemoglobin,albumin,calcium ion and lactate dehydrogenase were analyzed among patients with different stages of bone disease.Results Serum 25-( OH) D level in MM patients was significantly lower than that in healthy people[( 12. 4 ± 2. 7)μg/L vs( 21. 3 ±3. 2) μg/L,P =0. 007]. Higher rate of 25-( OH) D adequacy and lower rates of deficiency/serious deficiency were observed in MM patients with bone disease( n = 62) [3. 2%( 2/62),40. 3%( 25/62),30. 6%( 19/62) vs 19. 0%( 4/21),33. 3%( 7/21),9. 5%( 2/21) in MM patients without bone disease( n = 21),all P < 0. 05]. Serum 25-( OH) D level in International Staging System stage Ⅲ was significantly lower than that in stage Ⅰ and Ⅱ [( 7. 5 ± 2. 9) μg/L vs( 20. 2 ± 4. 2),( 18. 8 ± 3. 8) μg/L,both P < 0. 05 ];no statistical difference was observed between stage Ⅰ and Ⅱ( P > 0. 05). Serum 25-( OH) D level decreased with greater Durie-Salmon stage[( 23. 8 ± 4. 5),( 17. 5 ± 3. 6) μg/L,( 8. 5 ± 2. 4) μg/L for stage Ⅰ,Ⅱ,Ⅲ,all P < 0. 05].Pearson test showed that serum 25-( OH) D level was positively correlated with hemoglobin( r = 0. 452,P = 0. 021)and albumin( r = 0. 212,P = 0. 007);it was negatively correlated with β2-MG( r =-0. 415,P = 0. 023) and calcium ion( r =-1. 063,P = 0. 009). Conclusion The expression of 25-( OH) D in patients with MM is low,which may be associated with the severity and prognosis of disease.