血清β-CTx及TRACP-5b与多发性骨髓瘤骨病病情严重程度及预后关系

Correlation between serumβ-CTx and TRACP-5b and the severity and prognosis of multiple myeloma bone disease

目的探讨血清Ⅰ型胶原羧基端肽β特殊序列(β-CTx)及抗酒石酸酸性磷酸酶5b同工酶(TRACP-5b)与多发性骨髓瘤骨病(MMBD)病情严重程度及预后的关系。方法回顾分析2016年1月-2020年1月收治的MMBD患者142例。通过诊治指南和影像学检查结果将患者按病情严重程度分为1、2、3、4级组,采用酶联免疫吸附法(ELISA)检测4组血清β-CTx、TRACP-5b水平,比较4组血清指标变化情况,以Spearman分析血清β-CTx、TRACP-5b与MMBD严重程度的相关性。所有患者根据生存情况分为生存组与死亡组,采用Cox回归分析影响预后的相关因素。结果血清β-CTx、TRACP-5b水平随4组病情严重程度等级的增加而升高(P<0.05)。Spearman分析显示,血清β-CTx、TRACP-5b水平均与MMBD病情严重程度呈正相关(r=0.753、0.627,P<0.05)。142例患者截至随访时间生存98例,死亡44例,死亡组国际分期体系(ISS)Ⅲ期占比、MMBD严重程度4级占比、病理性骨折骨病类型占比、血清β2-MG、β-CTx及TRACP-5b水平较生存组更高(P<0.05)。β-CTx/TRACP-5b高、低水平的患者生存曲线差异具有统计学意义(P<0.05)。Cox回归分析显示,血清β-CTx、TRACP-5b、β2-MG水平、ISSⅢ期、MMBD严重程度4级、病理性骨折骨病类型是影响MMBD患者预后的危险因素(P<0.05)。结论血清β-CTx、TRACP-5b水平随MMBD病情严重程度的增加而升高,且二者是影响MMBD预后的危险因素。

Objective To explore the relationship between serum typeⅠcollagen carboxy-terminal peptideβ-specific sequence(β-CTx),anti-tartrate acid phosphatase 5b isoenzyme(TRACP-5b)and the severity and prognosis of multiple myeloma bone disease(MMBD).Methods The clinical data of 142 patients with MMBD from Jan.2016 to Jan.2020 were retrospectively analyzed.When treatment guidelines and imaging examination were performed,the patients were divide into levelⅠgroup,levelⅡgroup,levelⅢgroup and levelⅣgroup according to disease severity.Enzyme-linked immunosorbent assay(ELISA)were used to detect serum levels ofβ-CTx and TRACP-5b of the patients.Spearman was used to analyze the correlation between serumβ-CTx,TRACP-5b and severity of MMBD.All patients were divided into survival group and death group according to whether survived.Cox regression was used to analyze the related factors affecting prognosis.Results The serumβ-CTx and TRACP-5b increased with severity grade in four groups(P<0.05).Spearman analysis showed thatβ-CTx and TRACP-5b levels were positively correlated with the severity of MMBD(r=0.753,0.627,P<0.05).At the follow-up time,98 cases were survival and 44 cases were death in 142 patients.The proportion of International Staging System(ISS)levelⅢ,MMBD severity levelⅣ,bone disease of pathological fracture,β2-MG,β-CTx and TRACP-5b levels were higher in death patients than in survival patients(P<0.05).The difference in survival curves ofβ-CTx/TRACP-5b of patients was statistically significant(P<0.05).Cox regression analysis showed that the risk factors for affecting prognosis in MMBD patients wereβ-CTx,TRACP-5b,β2-MG levels,ISS levelⅢ,MMBD severity levelⅣ,and bone disease of pathological fracture(P<0.05).Conclusion Serumβ-CTx and TRACP-5b increase with the severity of MMBD,and both are the risk factors affecting prognosis of MMBD.