多发性骨髓瘤中循环骨髓瘤细胞水平及临床意义

The levels of circulating myeloma cells in multiple myeloma and its clinical value

目的分析多发性骨髓瘤患者外周血中循环骨髓瘤细胞(CMCs)水平及临床意义。方法将72例多发性骨髓瘤患者分为CMCs阳性组(CMCs占单核细胞比值≥1×10^(-4),40例)和CMCs阴性组(CMCs占单核细胞比值<1×10^(-4),32例)。比较两组年龄、性别、分期与分类资料、血红蛋白(Hb)、白蛋白(ALB)、Ca^(2+)、尿肌酐(Cr)、乳酸脱氢酶(LDH)和β_(2)微球蛋白(β_(2)MG)。免疫组化法检测两组骨髓组织中Ki67的表达情况。Pearson相关性分析检测CMCs与Hb、ALB、Ca^(2+)、LDH和β_(2)MG和Ki67阳性细胞比例之间的相关性。ROC曲线检测CMCs评估DS分期Ⅲ期、ISS分期Ⅲ期的临床价值。结果两组年龄、性别、分类、ALB、Ca^(2+)和LDH比较差异均无统计学意义(P>0.05),两组DS分期、ISS分期、Hb、Cr和β_(2)MG比较差异均有统计学意义(P<0.05)。Ki67阳性细胞比例CMCs阳性组显著高于CMCs阴性组(P<0.001)。CMCs与ALB、Ca^(2+)和LDH水平之间无相关性,与Hb水平呈负相关(P<0.001),与Cr、β_(2)MG和Ki67阳性细胞比例均呈正相关(P<0.001)。CMCs对DS分期Ⅲ期和ISS分期Ⅲ期均有一定的预测价值。结论多发性骨髓瘤中CMCs水平与Hb呈负相关,与Cr、β_(2)MG和Ki67阳性细胞比例呈正相关,对DS分期Ⅲ期和ISS分期Ⅲ期均有一定的预测价值。

Objective To analyze the levels of circulating myeloma cells(CMCs)in the peripheral blood of patients with multiple myeloma and theirclinical value.Methods The 72 patients with multiple myeloma were divided into CMCs positive group(CMCs to monocytes ratio≥1×10^(-4),40 cases)and CMCs negative group(CMCs to monocytes ratio<1×10^(-4),32 cases).The following data were compared between the two groups,including age,gender,stage,classification data,hemoglobin(Hb),albumin(ALB),Ca^(2+),urine creatinine(Cr),lactate dehydrogenase(LDH)andβ_(2) microglobulin(β_(2)MG).The expression of Ki67 in the bone marrow tissue of the two groups patients were detected by immunohistochemistry.Pearson correlation analysis was used to detect the correlation between CMCs and Hb,ALB,Ca^(2+),LDH,and β_(2)MG and Ki67 positive cells ratio.Receiveroperating curve(ROC)was used to analyze the clinical values ofⅢ-stage of DS staging andⅢ-stage of ISS staging assessed with CMCs.Results There were no statistical differences in age,gender,classification,ALB,Ca^(2+) and LDH between the two groups(P>0.05).There were all statistical differences in the DS staging,ISS staging,Hb,Crand β_(2)MG(P<0.05).The proportion of Ki67 positive cells in the CMCs positive group was significantly higherthan that in the CMCs negative group(P<0.001).There was no correlation between CMCs and ALB,Ca^(2+) and LDH levels,while there was negative correlation with Hb levels(P<0.001),and positive correlation with Cr,β_(2)MG and Ki67 positive cells rate(P<0.001).CMCs had certain predictive value forⅢ-stage of DS staging andⅢ-stage of ISS staging.Conclusions The level of CMCs in multiple myeloma is negatively correlated with Hb,and positively correlated with the expression levels of Cr,β_(2)MG and proportion of Ki67 positive cells,which has certain predictive value forⅢ-stage of DS staging andⅢ-stage of ISS staging.