多发性骨髓瘤患者血清补体C1q的变化

Changes of Serum Complement C1q in Patients with Multiple Myeloma

目的:探讨多发性骨髓瘤(MM)病程中患者血清补体C1q的变化,及其与临床特征间的关系。方法:选取2016年6月至2019年12月武汉大学中南医院收治的138例初诊MM住院患者为研究对象,另根据年龄匹配同期入院的贫血患者及非MM血液肿瘤患者,包括淋巴瘤、白血病及骨髓增生异常综合征各50例为对照(所有患者均符合WHO疾病分类标准,病理或骨髓涂片/活检明确诊断),比较MM患者与对照组间及MM患者治疗前后不同疗效组C1q水平的变化,比较不同C1q水平时MM患者临床特征间的差异,进而分析导致C1q下降的风险因素。结果:MM患者C1q平均值为(128.18±51.24)mg/L,明显低于贫血及非MM血液肿瘤患者(P<0.01)。初诊高C1q组患者的白细胞、血小板、血红蛋白、血清钙离子、白蛋白、乳酸脱氢酶水平均明显高于低C1q组(P<0.05)。进一步Logistic分析显示,初诊高C1q组患者的血小板、血红蛋白、白蛋白及乳酸脱氢酶水平均高于低C1q组(r=0.248,r=0.394,r=0.405,r=0.295)。治疗后疗效评估达到完全缓解、非常好的部分缓解的MM患者C1q水平均较治疗前明显升高(P<0.05),而部分缓解、病情稳定患者虽亦升高但无明显统计学意义(P>0.05)。结论:MM患者C1q水平明显低于血液系统其他疾病患者,且随着治疗后病情的缓解C1q表达较治疗前升高。

Objective: To analyze the change of serum C1 q in the course of multiple myeloma(MM) and its correlation with clinical characteristics. Methods: A total of 138 newly diagnosed MM patients in Zhongnan Hospital of Wuhan University from June 2016 to December 2019 were selected as research objects, during the same period 50 age-matched anemia patients, 50 lymphoma patients, 50 leukemia patients, and 50 myelodysplastic syndrome(MDS) patients were selected as control groups. All the patients met WHO disease classification, and were definitely diagnosed by pathology or bone marrow smear/biopsy. The changes of C1 q between MM patients and control group, as well as in different therapeutic responses of MM patients before and after treatment were compared, also the difference of clinical characteristics among MM patients with different C1 q level, so as to analyze risk factors which led to C1 q decline. Results: The average value of C1 q in MM patients was(128.18±51.24) mg/L, which was significantly lower than control group(P<0.01). The levels of white blood cell, platelet(PLT), hemoglobin(Hb), serum calcium, albumin, lactate dehydrogenase(LDH) in newly diagnosed high C1 q group were significantly higher than those in low C1 q group(P<0.05). Logistic analysis showed that the levels of PLT, Hb, albumin, and LDH in newly diagnosed high C1 q group were higher than those in low C1 q group(r=0.248, r=0.394, r=0.405, r=0.295). After treatment, the levels of C1 q in MM patients with complete remission and very good partial remission were significantly higher than before treatment(P<0.05), while those with partial remission and stable disease also increased but not significantly(P>0.05). Conclusion: The C1 q level in MM patients is significantly lower than that in patients with other hematologic system diseases, and it increases with the remission of the disease after treatment.