CONUT评分对多发性骨髓瘤患者预后的影响

The Influence of CONUT Score on the Prognosis of Patients with Multiple Myeloma

目的:探讨营养状况(CONUT)评分对初诊多发性骨髓瘤(MM)患者预后的影响。方法:收集并回顾性分析2010年4月至2018年10月在兰州大学第二医院根据国际骨髓瘤诊断标准明确诊断为MM的119例患者的临床资料,分析患者的年龄、性别、MM分型、淋巴细胞绝对数、中性粒细胞绝对数、单核细胞绝对数、血红蛋白、血小板数、β2-微球蛋白、乳酸脱氢酶、白蛋白、球蛋白、胆固醇、血肌酐等临床指标与CONUT评分之间的关系,探讨上述指标对初诊MM患者的预后价值。使用SPSS 25.0软件进行统计学分析。用Kaplan-Meier曲线计算各亚组之间无进展生存期(PFS)、总生存期(OS),生存曲线之间的差异采用双尾Log-rank检验;使用受试者工作特征曲线评估CONUT评分预测OS的最具区分性的临界值;对非参数分布的样本进行Mann-Whitney U检验,分类变量采用卡方检验;使用COX比例风险模型进行单变量和多变量分析,确定与OS相关的因素。结果:与高CONUT评分组相比,低评分组有更好的OS(中位OS分别为43.3和127.67个月,95%CI:57.065-78.345,P=0.038),同时,低评分组淋巴细胞绝对数、中性粒细胞绝对数、单核细胞绝对数、血红蛋白、血小板数、白蛋白和胆固醇的水平较高,但球蛋白水平降低。多因素生存分析显示,年龄(HR=1.027,95%CI:1.000-1.054,P=0.048)、单核细胞绝对数(HR=11.284,95%CI:22.968-42.897,P <0.001)、CONUT评分(HR=1.198,95%CI:1.036-1.385,P=0.015)、M蛋白(非Ig G/Ig G型)类型(HR=0.503,95%CI:0.259-0.977,P=0.043)是MM患者预后的独立影响因素。结论:CONUT评分作为免疫-营养评分是能有效预测MM患者预后且方便易得的指标。

Objective:To explore the influence of controlling nutritional status(CONUT) score on the prognosis of newly diagnosed patients with multiple myeloma(MM).Methods:The clinical data 119 patients with MM who were diagnosed according to the international myeloma diagnostic criteria in Lanzhou University Second Hospital from April2010 to October 2018 were collected and retrospectively analyzed.The relationship between clinical indexes,including age,sex,MM type,absolute lymphocyte count(ALC),absolute neutrophil count(ANC),absolute monocyte count(AMC),hemoglobin(Hb),platelet(PLT),β2-microglobulin(β2-MG),lactate dehydrogenase(LDH),albumin(ALB),globulin(GLO),cholesterol(CHO),serum creatinine(Scr),etc,and CONUT score was discussed to explore the prognostic value of these indicators.SPSS 25.0 software was used for statistical analysis.Progression-free survival(PFS) and overall survival(OS) between different subgroups were calculated by Kaplan-Meier curves and difference between survival curves was detected by Log-rank tests.Receiver operating characteristic(ROC) curve was used to estimate the most discriminative cutoff value of CONUT score for predicting OS.Mann-Whitney U test was used for non-parametric samples,and chi-square test for categorical variables.Univariate and multivariate analysis were performed by using COX proportional hazards model to identify factors associated with OS.Results:Compared with high-scoring group,low-scoring group had a better OS [median OS was 43.3 months and 127.67 months,respectively,95% confidence interval(CI):57.065-78.345,P=0.038].At the same time,the low-scoring group also had higher level of ALC,ANC,AMC,Hb,PLT,ALB,and CHO but lower of GLO.Multivariate survival analysis showed that age(HR=1.027,95% CI:1.000-1.054,P=0.048),AMC(HR=11.284,95% CI:22.968-42.897,P <0.001),CONUT score(HR=1.198,95% CI:1.036-1.385,P=0.015),M protein(non-IgG/IgG type) type(HR=0.503,95% CI:0.259-0.977,P=0.043) were independent factors affecting the prognosis of MM patients.Conclusion:The CONUT score as an immune-nutrition score is a convenient and easy-to-obtain index to effectively predict the prognosis of MM patients.