血清同型半胱氨酸水平对初诊多发性骨髓瘤患者预后的影响及相关因素分析

The Influence of Serum Homocysteine Level to the Prognosis of Newly Diagnosed Multiple Myeloma Patients and Analysis of Related Factors

目的:分析血清同型半胱氨酸(Hcy)水平对初诊多发性骨髓瘤(MM)患者预后的影响,并探讨其相关影响因素。方法:收集本院2013年3月-2015年2月初诊MM患者180例的临床病理资料,依据Hcy中位数将入组患者分为高、低Hcy组,绘制2组患者生存曲线,对比生存差异;单因素及多因素生存分析观察血清半胱氨酸对初诊MM患者预后的影响;比较高、低Hcy 2组患者临床病理资料,Pearson检验进一步分析Hcy与差异因素的相关性,探讨Hcy影响预后的相关因素。结果:高、低Hcy组患者中位生存期分别为32(5-59)和41(7-71)个月,高Hcy组3年生存率显著低于低Hcy组,差异有统计学意义(P<0.05)。单因素生存分析结果显示:高龄,高骨病分级,高水平骨髓浆细胞数、LDH、C反应蛋白、Cr、β2-MG、Hcy,低水平Hb、ALB的初诊MM患者的总生存期(OS)显著缩短(均P<0.05);多因素生存分析结果显示,高龄、高水平骨髓浆细胞数、Cr、β2-MG、低水平Hb、低水平ALB为初诊MM患者OS缩短的独立危险因素(均P<0.05),而Hcy与患者OS非独立相关(P>0.05)。高Hcy组Hb水平明显低于低Hcy组,LDH水平明显高于低Hcy组(均P<0.05),Pearson检验结果显示,血清Hcy与Hb呈负相关(r=-0.813,P<0.05),而与LDH呈正相关(r=0.726,P<0.05)。结论:血清Hcy水平与初诊MM患者的生存有相关趋势,受Hb等因素影响。

Objective:To analyze the influence of serum homocysteine(Hey)levels to the prognosis of newly diagnosed multiple myeloma(MM)patients,and to explore related factors affecting the prognosis of the patients.Methods:The clinical pathological data of 180 newly diagnosed MM patients treated in our hospital from March 2013 to February 2015 were collected,and the patients were divided into high and low Hey groups based on the median Hey.The survival curves of the patients in the two groups were drawn to compare the differences of the survival;univariate and multivariate survival analysis was used to observe the influence of serum cysteine to the prognosis of newly diagnosed MM patients;the clinicopathological data of the patients with high and low Hey in the two groups was compared,Pearson test was used to further analyzes the relationship between Hey and different factors,and explores the related factors of Hey affecting the prognosis of the patients.Results:The median survival times of patients in the high and low Hey groups were 32(5-59)and 41(7-71)months,respectively.The 3-year survival rate of the patients in high Hey group was significantly lower than those in low Hey group,and the difference shows statistically significant(P<0.05).The results of univariate survival analysis showed that the OS of newly diagnosed MM patients whom with advanced age,high bone disease grade,high-level bone marrow plasma cell count,LDH,Creactive protein,Cr,β2=MG,Hey,lowlevel Hb,and ALB was significantly shortened(all P<0.05).The results of multivariate survival analysis showed that old age,high levels of bone marrow plasma cells,Cr,β2-MG,low levels of Hb,and ALB were the independent risk factors shorting the overall survival(OS)time of newly diagnosed MM patients(all P<0.05),while Hey showed no independent relation for the OS of patients(P>0.05).The Hb level of the patients in high Hey group was significantly lower than those in low-Hcy group,while the LDH level was significantly higher than those in low Hey group(all P<0.05).Pearson test results showed that serum Hey and Hb showed negative correlation(r=-0.813,P<0.05),but it shows positive correlation with LDH(r=0.726,P<0.05).Conclusion:Serum Hey level has a correlation trend with the survival of newly diagnosed MM,which is affected by factors such as Hb.