血小板分布宽度与血小板计数比值对多发性骨髓瘤预后分析

Prognostic values of platelet distribution width-to-platelet count ratio for multiple myeloma

目的探讨外周血中血小板分布宽度(platelet distribution width,PDW)与血小板计数(platelet count)的比值(PDW/PLT)与多发性骨髓瘤(MM)患者临床特征和预后的关系。方法选取徐州医科大学附属医院2013年2月1日—2019年6月30日收治的初诊MM患者,共155例,收集其临床资料。依据PDW/PLT的最佳截断值,将患者分为高PDW/PLT组(PDW/PLT≥0.066)和低PDW/PLT组(PDW/PLT<0.066),比较2组MM患者在临床特征、疗效及预后方面的差异。结果研究结果显示,高PDW/PLT组与低PDW/PLT组在年龄(P=0.010)、Durie Salmon(DS)分期(P=0.003)、国际分期系统(ISS)分期(P=0.003)、血红蛋白(Hb)(P=0.039)、血小板(PLT)(P=0.000)、血清肌酐(Scr)(P=0.002)、血清钙(Ca)(P=0.041)、β_(2)-微球蛋白(β_(2)-MG)(P=0.001)、乳酸脱氢酶(LDH)(P=0.004)、缓解程度(P=0.002)方面比较,差异有统计学意义。单因素生存分析结果显示,DS分期Ⅲ期、ISS分期Ⅲ期、Hb<100 g/L、白蛋白(Alb)<35 g/L、乳酸脱氢酶(LDH)≥250 U/L、β_(2)-MG≥5.5 mg/L、PDW/PLT≥0.066、无效缓解是影响MM患者预后的不良因素。多因素分析显示,PDW/PLT≥0.066、LDH≥250 U/L、无效缓解是影响MM患者总生存期(OS)的独立预后因素。结论初诊时外周血PDW/PLT≥0.066与MM患者的生存时间缩短有关,提示外周血PDW/PLT或可作为新的指标与现有预后指标结合来更好地判断MM患者的预后。

Objective To investigate the relationship between platelet distribution width-to-platelet count ratio(PDW/PLT)in peripheral blood ard the clinical characteristics and prognosis of patients with multiple myeloma(MM).Methods A total of 155 MM patients who were admitted to the Affiliated Hospital of Xuzhou Medical University from February 1,2013 to June 30,2019 were enrolled and their clinical data were collected.According to the optimal cut-off value of PDW/PLT,they were divided into two groups:a high PDW/PLT group(PDW/PLT≥0.066)and a low PDW/PLT group(PDW/PLT<0.066).Both groups were compared for clinical characteristics,effectiveness and prognosis.Results Statistical differences were found in age(P=0.010),Durie Salmon(DS)stages(P=0.003),International Staging System(ISS)stages(P=0.003),hemoglobin(Hb)(P=0.039),platelets(PLT)(P=0.000),serum creatinine(Scr)(P=0.002),serum calcium(Ca)(P=0.041),β_(2)-microglobulin(β_(2)-MG)(P=0.001),lactate dehydrogenase(LDH)(P=0.004),and the degree of remission(P=0.002)between the high PDW/PLT group and the low PDW/PLT group.Univariate survival analysis results showed that DS stageⅢ,ISS stageⅢ,Hb<100 g/L,albumin(Alb)<35 g/L,LDH≥250 U/L,β_(2)-MG≥5.5 mg/L,PDW/PLT≥0.066 and ineffective remission were the factors affecting the prognosis of MM patients.Furthermore,multivariate analysis showed that PDW/PLT≥0.066,LDH≥250 U/L,and ineffective remission were the independent prognostic factors affecting OS in MM patients.Conclusions Peripheral blood PDW/PLT≥0.066 at the first diagnosis is related to the shortened survival time of MM patients.It suggests that peripheral blood PDW/PLT may be used as a new indicator,which if used in combined with current prognostic indicators can better predict the prognosis of MM patients.