CD40/CD40L在MM患者中的表达及其对预后的意义

The Expression of CD40/CD40L in MM Patients and Its Significance to the Prognosis of MM Patients

目的:探讨CD40/CD40L在多发性骨髓瘤(MM)患者中的表达及其对预后的影响。方法:选取2016年5月-2017年6月于沧州市人民医院接受治疗的MM患者30例,作为MM组,同期选取在本院体检的健康人30例为正常组,采用流式细胞术检测两组人员血清中化疗前后CD40/CD40L的水平,分析其与MM患者淋巴细胞群、病理分级及预后的相关性。结果:MM组患者血清中CD40表达水平显著高于正常组(P<0.05);MM组患者血清中CD40L表达水平与正常组比较无统计学意义(P>0.05);MM组患者化疗前后的CD40、CD40L水平比较无统计学差异(P>0.05);Ts细胞及NK细胞水平在MM组患者中的表达低于正常组(P<0.05),总B淋巴细胞、Th细胞、Th/Ts占比两组比较无统计学意义(P>0.05);CD40水平与MM组患者血清总B淋巴细胞水平存在相关性(r=0.877,P=0.005),CD40L与MM患者血清中Th细胞存在相关性(r=-0.783,P=0.035);Ⅲ-Ⅳ期MM患者血清CD40表达高于Ⅰ-Ⅱ期MM患者,不同时期MM组患者血清CD40L水平比较无统计学意义(P>0.05);CD40高表达MM患者生存率低于CD40低表达的MM患者(χ^2=1.639,P=0.201)。CD40水平高表达为MM患者预后的主要影响因素(95%CI:1.156-4.125)。结论:MM血清中CD40水平升高与患者病理分级有关,接受化疗能够降低CD40水平,CD40升高是MM患者预后较差的重要因素,CD40L水平与MM治疗及预后无意义。

Objective;To explore the expression of CD40/CD40L in multiple myeloma(MM)patients and its influence on prognosis.Methods;Thirty patients with MM treated in Cangzhou People's Hospital from May 2016 to June 2017 were selected and divided into MM group,then 30 healthy people with a physical examination in our hospital at the same time were selected as the normal group.The serum CD40/CD40L levels of the patients in the two groups was detected by flow cytometry,and its correlation with the lymphocyte population,pathological grade and prognostic significance of MM patients was anaysis.Results:The expression of CD40 in serum of the patients in MM group was significantly higher than those in normal group(P<0.05).The expression of CD40L in serum of the patients in MM group showed no significant difference as compared with those in normal group(P>0.05).The levels of CD40 and CD40L in the patients before and after chemotherapy showed no difference(P>0.05).The levels of Ts and NK cells in the patients of MM group were lower than those in normal group(P<0.05).The proportion of total B lymphocytes,Th and Th/Ts cells between the two groups showed no significant difference(P>0.05).The CD40 level was correlated with the serum total B lymphocyte level of the patients in MM group(r=0.877,P=0.005).There was a correlation with CD40L and Th cells in the serum of MM patients(r=-0.783,P=0.035).The expression of serum CD40 in the patients at phaseⅢ-Ⅳwas higher than those of the patients at phaseⅠ-Ⅱ,the levels of serum CD40L in MM patients at different periods showed no significant difference(P>0.05).The survival rate of MM patients with high CD40 expression was lower than that of MM patients with low CD40 expression(χ^2=1.639,P=0.201).The high level CD40 was the main factor affecting the prognosis of MM patients(95%CI:1.156-4.125).Conclusion;The increasing of CD40 level in MM patients is related to the pathological grade of the patients.Chemotherapy can reduce the level of CD40.The increasing of CD40 is an important factor for the poor prognosis of MM patients.CD40L level is not-meaningful for MM treatment and prognosis.