半胱氨酸蛋白酶抑制剂C血游离轻链水平对多发性骨髓瘤肾损伤患者BTD治疗方案疗效的预估价值研究

Study on the predictive value of CysC and FLC levels in the treatment of BTD in patients with multiple myeloma and renal injury

目的讨论半胱氨酸蛋白酶抑制剂C(Cys C)、血游离轻链(FLC)水平对多发性骨髓瘤肾损伤患者BTD方案(硼替佐米+沙利度胺+地塞米松)疗效的预估价值。方法选择2017年6月至2018年1月汉中市中心医院多发性骨髓瘤肾损害患者78例,所有患者均接受BTD方案进行化疗。根据患者化疗效果分成完全缓解(CR)组和部分缓解(PR)组,对比2组患者化疗前后Cys C、FLC-κ/λ比值变化,分析Cys C、FLC-κ/λ比值单独或者联合在多发性骨髓瘤肾损伤疗效判断中的应用;分析不同Cys C水平、FLC-κ/λ比值患者不良反应发生情况、复发率以及总生存时间(OS)。结果CR组患者Cys C水平、FLC-κ/λ比值均明显低于PR组(P<0.05);经受试者工作特征曲线(ROC)分析,Cys C、FLC-κ/λ比值在疗效判断中的曲线下面积(AUC)分别为0.912和0.938,两者联合在疗效判断中的AUC为0.973;Cys C与FLC-κ/λ比值联合对疗效的判断的敏感度及特异度优于两者单独应用。随访2年,患者不良反应发生率为24%(19/78),复发率为10%(8/78);FLC-κ/λ比值≤1.398不良反应发生情况及复发情况与FLC-κ/λ比值>1.398差异无统计学意义(P>0.05);Cys C≤0.883 mg/L不良反应发生情况及复发情况与Cys C>0.883 mg/L差异无统计学意义(P>0.05);对患者生存情况进行分析后发现,FLC-κ/λ比值≤1.398患者的中位生存时间较长,明显较FLC-κ/λ比值>1.398的16.5个月长(P<0.05);Cys C≤0.883 mg/L患者的中位生存时间较长,明显较Cys C>0.883 mg/L的20个月长(P<0.05)。结论多发性骨髓瘤肾损伤患者BTD治疗后的CR患者CysC、FLC水平明显低于PR患者,两者联合对多发性骨髓瘤肾损伤患者治疗效果的预估价值更高;且CysC、FLC-κ/λ比值均能够在一定程度上预测患者的预后。

Objective To investigate the predictive value of cystatin C(Cys C)and blood free light chain(FLC)levels in the treatment of BTD in patients with multiple myeloma and renal injury.Methods From June 2017 to January 2018,78 patients with multiple myeloma and renal damage in Hanzhong Central Hospital were selected.All patients received BTD chemotherapy.According to the effect of chemotherapy,they were divided into CR group and PR group.The changes of Cys C,FLC-κ/λratio before and after chemotherapy were compared between the two groups,and the relationship between Cys C,FLC-κ/λratio and efficacy was analyzed;the occurrence of adverse reactions,recurrence rate,total survival time(OS)and disease-free survival time(DFS)were analyzed.Results The level of Cys C and the FLC-κ/λratio in CR group were significantly lower than those in PR group(P<0.05),and the level of Ccr in CR group was significantly higher than that in PR group(P<0.05);according to ROC analysis,AUC of Cys C and FLC-κ/λratio was 0.912 and 0.938 respectively,and AUC of combination of them was 0.973;the sensitivity and specificity of the combination of Cys C and FLC-κ/λratio in the evaluation of curative effect were significantly better than that of the combination of Cys C and FLC-κ/λratio in the evaluation of curative effect.Follow up for 2 years,the incidence of adverse reactions was 24%(19/78),the recurrence rate was 10%(8/78),there was no significant difference in the occurrence and recurrence of adverse reactions between FLC-κ/λratio≤1.398 and FLC-κ/λratio>1.398(P>0.05).There was no difference in the occurrence and recurrence of adverse reactions between Cys C≤0.883 mg/L and Cys C>0.883 mg/L(P>0.05).The median survival time of patients with FLC-κ/λratio≤1.398 was significantly longer than that of patients with FLC-κ/λratio>1.398(P<0.05).The median survival time of patients with Cys C≤0.883 mg/L was significantly longer than that of patients with Cys C>0.883 mg/L(P<0.05).Conclusion The CysC and FLC levels of CR patients after BTD treatment were significantly lower than those of PR patients,and the combination of the two had a higher predictive value for the therapeutic effect of multiple myeloma patients with renal injury,and the CysC and FLC-κ/λratio could predict the prognosis of patients to a certain extent.