血清唾液酸水平在多发性骨髓瘤患者中的变化及其临床意义

Expression of serum sialic acid levels in patients with multiple myeloma and its clinical significance

目的:探讨不同分型多发性骨髓瘤(MM)患者血清唾液酸水平及其临床意义。方法:回顾性分析2013年1月1日—2019年10月31日青岛大学附属医院的175例MM患者,对其临床特点、实验室检查结果及预后进行统计学分析。结果:IgA型患者、轻链型患者唾液酸水平明显高于健康者(P<0.05),而IgG型患者唾液酸水平与健康者比较差异无统计学意义(P>0.05),同时IgA型患者唾液酸水平明显高于轻链型患者(P<0.05)。IgA型患者的唾液酸水平与球蛋白、尿酸、血沉、血钙、单克隆免疫球蛋白、受累轻链与未受累轻链比值、骨髓涂片浆细胞数呈正相关(P<0.05),与血红蛋白、白蛋白、乳酸脱氢酶呈负相关(P<0.05);轻链型患者的唾液酸水平与球蛋白、肌酐、血沉、受累轻链与未受累轻链比值呈正相关(P<0.05),与血红蛋白呈负相关(P<0.05)。在IgA型及轻链型患者中唾液酸水平随疾病的不同阶段动态变化,当疾病缓解时唾液酸水平降低,疾病进展时唾液酸水平升高。多因素分析表明,唾液酸是轻链型MM的预后独立危险因素。轻链型患者中高唾液酸组与低唾液酸组的Kaplan-Meier生存分析显示,高唾液酸组有更短的无进展生存期(16.96个月,95%CI 10.0323.87 vs 34.07个月,95%CI 27.0041.14,P=0.003)。结论:血清唾液酸可作为反映IgA型及轻链型MM患者肿瘤负荷的良好指标,且初诊时高唾液酸往往提示预后不良。

Objective: To investigate the role of serum sialic acid(SA) in evaluating different types of multiple myeloma(MM) patients. Methods: We retrospectively reviewed the clinical data from 175 patients with MM who treated in the Affiliated Hospital of Qingdao University from January 2013 to October 2019. Data on clinical manifestations, laboratory findings and prognosis were analyzed. Results: Compared with the healthy group, the IgA group and light chain group had significantly higher level of serum SA(P<0.05), while there was no significant difference between IgG group and healthy group(P>0.05). And the SA level in IgA group was higher than that in light chain group(P<0.05). Then, Spearman correlation showed serum SA in IgA group was positively correlated with globulin, uric acid, erythrocyte sedimentation rate, blood calcium, monoclonal immunoglobulin, the ratio of involved light chain to uninvolved light chain, and the number of plasma cells in bone marrow smears(P<0.05), and negatively correlated with hemoglobin, albumin and lactate dehydrogenase(P<0.05). While in patients in light chain group, the serum SA was positively correlated with globulin, creatinine, erythrocyte sedimentation rate, the ratio of involved light chain to uninvolved light chain(P<0.05), and negatively correlated with hemoglobin(P<0.05). SA in patients with IgA type and light chain type decreased when the disease was in remission, and increased when the disease was in progression. SA was an independent prognostic factor for light chain type MM in multivariate analysis. Kaplan-Meier survival analysis showed light chain patients in higher SA subgroup had shorter PFS compared with low SA subgroup(16.96 months[95%CI 10.03-23.87] vs 34.07 months[95%CI 27.00-41.14], P=0.003). Conclusion: SA can be used a good indicator of tumor burden in MM patients with IgA type and light chain type. Furthermore, high SA at initial diagnosis often indicates a poor prognosis.