多发性骨髓瘤患者血脂指标水平及预后意义

Serum Lipid Levels and Their Prognostic Significance in Patients with Multiple Myeloma

目的:探讨多发性骨髓瘤(MM)患者血脂指标水平及其预后意义。方法:选取2012年1月至2021年4月我院初诊MM患者87例及健康体检对照者87例。比对MM患者与健康对照者血脂水平;分析性别、年龄、血红蛋白(Hb)、白蛋白(ALB)、血小板(PLT)、β2⁃微球蛋白(β2⁃MG)、骨髓浆细胞比例(BMPC)两分组间、不同免疫分型、ISS分期及化疗前后患者血脂水平差异;单因素及COX多因素回归分析血脂指标等临床参数对MM预后的影响。结果:MM患者血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL⁃C)、高密度脂蛋白胆固醇(HDL⁃C)、载脂蛋白A1(Apo A1)、载脂蛋白B(Apo B)水平均明显低于健康对照者(P<0.05)。患者贫血、低蛋白、低PLT与低胆固醇有关,低Hb、ALB者TC、LDL⁃C、HDL⁃C、Apo A1、Apo B水平均明显低于高Hb、ALB者(P<0.05),低PLT者Apo B水平明显低于高PLT者(P<0.05)。TC、LDL⁃C、HDL⁃C、Apo A1、Apo B水平在不同免疫分型患者间差异有统计学意义,IgA型上述指标明显低于IgG型(P<0.05),IgG型明显低于轻链型(P<0.05),双克隆型明显低于轻链型(P<0.05)。TC、LDL⁃C、Apo B水平在不同ISS分期患者间差异有统计学意义,Ⅱ期低于Ⅰ期(P>0.05),Ⅲ期均明显低于Ⅱ、Ⅰ期(P<0.05)。化疗后患者TC、TG、LDL⁃C、HDL⁃C、Apo A1、Apo B水平均明显高于化疗前(P<0.05)。单因素分析结果显示,Hb、PLT、β2⁃MG、BMPC、LDL⁃C、Apo B影响MM预后;多因素分析结果显示,BMPC、Apo B是MM预后的独立影响因素。结论:MM患者血清胆固醇水平降低,且低胆固醇血症与疾病分型分期有关,随着疾病好转,血清胆固醇水平升高,低血清Apo B水平预示较差的预后。

Objective:To investigate the serum lipid levels and their prognostic significance in patients with multiple myeloma(MM).Methods:A total of 87 newly diagnosed MM patients and 87 healthy controls in our hospital from January 2012 to April 2021 were selected.Serum lipid levels were compared between MM patients and healthy controls.The differences of serum lipid levels in patients among two groups of sex,age,hemoglobin(Hb),albumin(ALB),platelet(PLT),β2⁃microglobulin(β2⁃MG)and bone marrow plasma cell ratio(BMPC),different immune types,different ISS stages,before and after chemotherapy were analyzed.Univariate and COX multivariate regression analysis were used to analyze the influence of clinical parameters such as serum lipid indexes on prognosis of MM.Results:The serum levels of total cholesterol(TC),low density lipoprotein cholesterol(LDL⁃C),high density lipoprotein cholesterol(HDL⁃C),apolipoprotein A1(Apo A1)and apolipoprotein B(Apo B)in MM patients were significantly lower than those in healthy controls(P<0.05).Anemia,low protein and low PLT in patients were related to low cholesterol.The levels of TC,LDL⁃C,HDL⁃C,Apo A1 and Apo B in patients with low Hb and ALB were significantly lower than those in patients with high Hb and ALB(P<0.05).The Apo B level of low PLT patients was significantly lower than that of high PLT patients(P<0.05).The levels of TC,LDL⁃C,HDL⁃C,Apo A1 and Apo B in patients with different immune types were significantly different,the above indexes of IgA type were significantly lower than IgG type(P<0.05),IgG type were significantly lower than light chain type(P<0.05),double clone type were significantly lower than light chain type(P<0.05).The levels of TC,LDL⁃C,and Apo B in patients with different ISS stages were significantly different,stageⅡwere lower than those of stageⅠ(P>0.05),stageⅢwere significantly lower than those of stageⅡand stageⅠ(P<0.05).The levels of TC,TG,LDL⁃C,HDL⁃C,Apo A1 and Apo B in patients after chemotherapy were significantly higher than those before chemotherapy(P<0.05).Univariate analysis showed that Hb,PLT,β2⁃MG,BMPC,LDL⁃C and Apo B affected the prognosis of MM.Multivariate analysis showed that BMPC and Apo B were independent factors affecting the prognosis of MM.Conclusion:The serum cholesterol level is decreased in MM patients,and hypocholesterolemia is related to the classification and staging of the disease.With the improvement of the disease,the serum cholesterol level is increased,and low serum Apo B level predicts a poor prognosis.