化疗前AGR在多发性骨髓瘤患者预后评估中的价值

The Value of AGR in the Prognosis of Multiple Myeloma Patients before Chemotherapy

目的分析化疗前白蛋白与球蛋白比值(AGR)对多发性骨髓瘤(MM)患者总生存期的影响。方法选取124例MM初诊患者,80例健康体检者,利用ROC曲线确定AGR诊断MM的cut-off值,根据cut-off值将MM患者分为低AGR(≤1.6)组和高AGR(>1.6)组,分析比较两组患者的临床资料及实验指标与总生存期的关系。结果低AGR组和高AGR组的血小板、血红蛋白、总蛋白、白蛋白、球蛋白水平及免疫球蛋白类型分布差异均具有统计学意义(P<0.05),而性别、年龄、校正血清钙、骨髓瘤细胞及轻链类型的差异无统计学意义(P>0.05)。Kaplan-Meier法分析显示,性别、年龄、校正血清钙、轻链类型与总生存期无关(P>0.05),而血小板、白蛋白、球蛋白、AGR及免疫球蛋白类型与总生存期有关(P<0.05),低AGR组患者的生存期中位数为24个月(95%CI:21-36),高AGR组患者的生存期中位数为43个月(95%CI:34-80),两者差异有统计学意义(P<0.05)。COX回归模型多因素分析显示,PLT和AGR是影响MM患者总生存期的独立危险因素(P<0.05)。结论低AGR患者的总生存期较高AGR患者短;低PLT患者的总生存期较高PLT患者短,低AGR及低PLT可作为影响MM患者总生存期的独立危险因素。

Objective To analyze the effect of the ratio of albumin to globulin(AGR)before chemotherapy on the overall survival of patients with multiple myeloma(MM).Methods 124 newly diagnosed MM patients and 80 healthy persons were selected,cut-off value of AGR was determined by ROC curve,according to cut-off value,MM patients were divided into low AGR(≤1.6)group and high AGR(>1.6)group,the relationship between clinical data and experimental indexes and total survival period was analyzed and compared between the two groups.Results The levels of platelet,hemoglobin,total protein,albumin,globulin and the types of immunoglobulin in the low AGR group and the high AGR group were statistically significant(P<0.05),but there was no statistically significant difference in gender,age,corrected serum calcium,myeloma cells and light chain types(P>0.05).Kaplan-Meier analysis showed that gender,age,adjusted serum calcium,light chain type were not related to the total survival time(P>0.05),while platelet,albumin,globulin,AGR and immunoglobulin types were related to the total survival time(P<0.05),the median survival time of low AGR group was 24 months(95%CI:21-36),and that of high AGR group was 43 months(95%CI:34-80),the difference was statistically significant(P<0.05).The multivariate analysis of COX regression model showed that PLT and AGR were independent risk factors for the overall survival of MM patients(P<0.05).Conclusion The total survival time of patients with low AGR is shorter than that of patients with low PLT.Low AGR and low PLT can be used as independent risk factors for the total survival time of MM patients.