多发性骨髓瘤患者RPR及相关指标的临床分析

Clinical analysis of RPR and related indexes in patients with multiple myeloma

目的:研究简便易得的血细胞参数红细胞分布宽度与血小板计数比值(red blood cell distributioin width to platelet ratio,RPR)在多发性骨髓瘤(multiple myeloma,MM)诊治及分期中的临床意义,结合相关指标综合分析RPR的应用价值。方法:收集2013年10月至2018年10月在华北理工大学附属医院确诊的MM 51例为病例组,另选取本院同期健康体检者51例作为对照组进行回顾性分析。比较2组间RPR、炎症指标红细胞分布宽度(red blood cell distributioin width,RDW)、C反应蛋白(Creactive protein,CRP)、白球比(albumin/globumin,A/G)、出凝血指标血小板计数(platelet,PLT)、平均血小板体积(mean platelet volume,MPV)、D-二聚体(D-dimmer,D-D)、经典分期指标β_(2)-微球蛋白(beta 2-macroglobulin,β_(2)-MG)及预后评估指标乳酸脱氢酶(lactate dehydrogenase,LDH)的差异;对MM患者按MM国际分期系统(international staging system,ISS)分期标准分为Ⅰ期、Ⅱ期、Ⅲ期3组,分析RPR及相关指标在不同分期之间的差异;分析病例组RPR分别与炎症指标A/G、出凝血指标MPV和D-D,经典分期指标β_(2)-MG的相关性。结果:病例组和对照组2组间RPR、炎症指标、出凝血指标、经典分期指标及预后评估指标比较,2组间差异均具有统计学意义(P=0.000、0.000、0.000、0.000、0.004、0.006、0.000、0.000、0.000)。病例组组间各指标比较,RPR等指标差异均具有统计学意义(P=0.000),且经两两比较,RPR、RDW、CRP、LDH、D-D、β_(2)-MG水平随疾病发展有增高趋势,而PLT、A/G、MPV水平随疾病发展有降低趋势。病例组RPR与出凝血指标D-D和经典分期指标β_(2)-MG分别呈正相关关系(r=0.590、0.803;均P=0.000);RPR与炎症指标A/G和出凝血指标MPV分别呈负相关关系(r=-0.583、-0.500;均P=0.000)。结论:RPR可同时反映炎症和出凝血状态,对MM的诊治和分期具有一定临床辅助意义。

Objective:To study the clinical significance of red blood cell distributioin width to platelet ratio(RPR)in the diagnosis,treatment and staging of multiple myeloma(MM),and to comprehensively analyze the applicative value of RPR combined with other relevant indicators. Methods:A total of 51 eligible MM patients who were diagnosed in the North China University of Science and Technology Affiliated Hospital from October 2013 to October 2018 were collected as the case group,while 51 healthy subjects who underwent examination in the same period of time in the same hospital were selected as the control group for retrospective analysis.RPR was calculated based on blood routine results,and the differences in RPR,inflammatory indexes including,red blood cell distribution width(RDW),C-reactive protein(CRP),albumin/globumin(A/G),platelet(PLT),mean platelet volume(MPV),D-dimmer (D-D),classic staging index beta 2-macroglobulin(β_(2)-MG)and prognostic evaluation indicator lactate dehydrogenase(LDH)between two groups were compared. According to ISS staging criteria,MM patients were divided into three groups:phase Ⅰ,Ⅱ,and Ⅲ. The differences between RPR and related indexes in different stages were analyzed. The correlation of RPR and inflammatory indicators A/G,coagulation indicators MPV and D-D,and classical staging indicator β_(2)-MG were respectively studied in the case group. Results :There were statistically significant differences in RPR,inflammatory indexes,coagulation indexes,the classic staging index and prognosis evaluation indicator between the case group and the control group(P=0.000,0.000,0.000,0.000,0.004,0.006,0.000,0.000,0.000). For the comparison of indicators among three groups,RPR and other indicators had statistical significance(P=0.000). By pairwise comparison,levels of RPR,RDW,CRP,LDH,D-D and β_(2)-MG were increased with the development of the disease,while levels of PLT,A/G and MPV were decreased with the development of the disease. For the correlation analysis between RPR and some indicators in the case group,RPR was positively correlated with D-D and β_(2)-MG(r=0.590,0.803;P=0.000,0.000),and was negatively correlated with A/G and MPV(r=-0.583,-0.500;P=0.000,0.000). Conclusion:RPR can reflect the inflammation and bleeding state,and has certain clinical auxiliary significance for the diagnosis,treatment and staging of MM.