多发性骨髓瘤患者外周血NLR水平与T淋巴细胞亚群的相关性及对预后的影响

Correlation between peripheral blood neutrophil to lymphocyte ratio level and T lymphocyte subsets in patients with multiple myeloma and its impact on prognosis

目的探讨多发性骨髓瘤(multiple myeloma,MM)患者外周血中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)水平与T淋巴细胞亚群的相关性及对预后的影响。方法选择2016年6月-2018年1月在浙江省立同德医院接受诊治的80例MM患者,设为MM组;选择同期在浙江省立同德医院体检的健康者60例,设为健康对照组。比较2组研究对象NLR水平、外周血T细胞亚群及NK细胞水平,Pearson法分析MM组NLR与T细胞亚群水平的相关性。另将MM组分为高NLR水平组(NLR≥2.69,38例)和低NLR水平组(NLR<2.69,42例),进行2组生存曲线绘制及生存率比较。结果MM组NLR、CD8^(+)水平明显高于健康对照组[2.69±0.74 vs.1.72±0.45,(44.34±5.04)%vs.(25.36±3.54)%,t=9.614、26.133,均P<0.05],CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平明显低于健康对照组(均P<0.05),NK细胞水平比较差异无统计学意义(P>0.05)。MM患者NLR水平与CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)呈负相关(r=-0.483、-0.481、-0.595,均P<0.05),与CD8^(+)呈正相关(r=0.318,P<0.05)。高NLR组2年生存率、2年无进展生存率明显低于低NLR组(均P<0.05)。结论MM患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平明显低于健康人群,NLR、CD8^(+)水平明显高于健康人群,机体NLR水平与患者免疫功能密切相关,高NLR水平提示MM患者预后不良。

Objective To investigate the correlation between the ratio of peripheral blood neutrophil to lymphocyte(NLR)level and T lymphocyte subsets in patients with multiple myeloma(MM)and its effect on prognosis.Methods Eighty patients with MM who were treated in Zhejiang Tongde Hospital from June 2016 to January 2018 were selected as the MM group;60 healthy people who were examined in our hospital during the same period were selected as the healthy control group.The levels of NLR,peripheral blood T cell subsets and NK cells were compared between the two groups.Pearson method was used to analyse the correlation between NLR and T cell subsets levels in the MM group.In addition,the patients with MM were divided into the high NLR level group(NLR≥2.69;38 cases)and low NLR level group(NLR<2.69;42 cases).The survival curves were drawn,and the survival rates were compared between the two groups.Results The levels of NLR and CD8^(+)in the MM group were significantly higher than those in the healthy control group[2.69±0.74 vs.1.72±0.45,(44.34±5.04)%vs.(25.36±3.54)%,t=9.614,26.133,all P<0.05],the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the MM group were obviously lower than those in the healthy control group(all P<0.05),and no significant difference in the level of NK cells was found between the two groups(P>0.05).In the patients with MM,NLR negatively correlated with CD3^(+),CD4^(+),CD4^(+)/CD8^(+)(r=-0.483,-0.481,-0.595,all P<0.05)and positively correlated with CD8^(+)(r=0.318,P<0.05).The two-year survival rate and the two-year progression-free survival rate of the high NLR group was obviously lower than those of the low NLR group(all P<0.05).Conclusion The CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)levels in the patients with MM are obviously lower than those in healthy people,and the NLR and CD8^(+)levels in the patients with MM are obviously higher than those in healthy people.The level of NLR is closely related to the immune function of patients.High NLR levels and abnormal expression of peripheral T lymphocyte subsets suggest a poor prognosis in patients with MM.