血清MIP-1α、TRACP-5b和骨硬化蛋白水平在多发性骨髓瘤病情和预后中的临床价值

Clinical value of serum MIP-1α,TRACP-5b and sclerostin levels in the condition and prognosis of multiple myeloma

目的探讨血清巨噬细胞炎症蛋白-1α(MIP-1α)、抗酒石酸酸性磷酸酶5b(TRACP-5b)和骨硬化蛋白水平在多发性骨髓瘤病情和预后中的临床价值。方法选取2019年1月至2020年12月在该院就诊的125例多发性骨髓瘤患者作为观察组;另选取同期在该院体检的75例健康体检者作为对照组。比较观察组患者治疗前后血清MIP-1α、TRACP-5b和骨硬化蛋白水平,以及观察组和对照组血清MIP-1α、TRACP-5b和骨硬化蛋白水平;比较不同肿瘤分期、不同骨质破坏程度分级多发性骨髓瘤患者血清MIP-1α、TRACP-5b和骨硬化蛋白水平,分析多发性骨髓瘤患者1年内发生死亡的单因素和多因素;比较血清MIP-1α、TRACP-5b和骨硬化蛋白单项及3项指标联合检测对多发性骨髓瘤患者1年内发生死亡的预测效能。结果观察组治疗前后血清MIP-1α、TRACP-5b和骨硬化蛋白水平均明显高于对照组,差异均有统计学意义(P<0.05);观察组患者治疗后血清MIP-1α、TRACP-5b和骨硬化蛋白水平较治疗前均明显降低,差异均有统计学意义(P<0.05)。多发性骨髓瘤患者血清MIP-1α、TRACP-5b和骨硬化蛋白水平随着多发性骨髓瘤肿瘤分期和骨质破坏程度分级升高而升高,差异均有统计学意义(P<0.05)。死亡组患者肿瘤分期、骨质破坏程度分级、MIP-1α水平、TRACP-5b水平和骨硬化蛋白水平与存活组比较,差异均有统计学意义(P<0.05)。多因素分析结果显示,肿瘤分期、骨质破坏程度分级、MIP-1α水平、TRACP-5b水平和骨硬化蛋白水平是多发性骨髓瘤患者1年内发生死亡的影响因素(P<0.05)。血清MIP-1α、TRACP-5b和骨硬化蛋白水平对多发性骨髓瘤患者1年内发生死亡具有较高的预测效能,3项指标联合检测的灵敏度为90.0%,特异度为87.1%,受试者工作特征曲线下面积(AUC)为0.934,明显高于MIP-1α(Z=3.068,P=0.002)、TRACP-5b(Z=3.622,P<0.001)和骨硬化蛋白(Z=2.576,P=0.010)单独检测,而3项指标之间的AUC比较,差异无统计学意义(P>0.05)。结论MIP-1α、TRACP-5b和骨硬化蛋白参与了多发性骨髓瘤疾病的发生和发展,对预测其1年内发生死亡具有较高的价值。

Objective To investigate the clinical value of serum macrophage inflammatory protein(MIP)-1α,tartrate-resistant acid phosphatase 5b(TRACP-5b)and sclerostin levels in the condition and prognosis of multiple myeloma.Methods A total of 125 patients with multiple myeloma who were treated in our hospital from January 2019 to December 2020 were selected as the observation group.Seventy-five patients who received physical examinations in our hospital during the same period were selected as the control group.The serum levels of MIP-1α,TRACP-5b and sclerostin in patients with multiple myeloma were compared with those after treatment and in the control group,and the serum levels of those were also compared with the disease classification and 1-year death.Efficacy of single and combined detection in predicting death within one year in patients with multiple myeloma nere compared.Results The serum levels of MIP-1α,TRACP-5b and sclerostin in the observation group before and after vetment were significantly higher than those in the control group(P<0.05),and levels of those after treatment were significantly lower than those before treatment(P<0.05).The serum levels of MIP-1α,TRACP-5b and sclerostin in patients with multiple myeloma increased with the stage of multiple myeloma and the grade of bone damage increased(P<0.05).The tumor stage,grade of bone destruction,MIP-1α,TRACP-5b and sclerostin levels in the death group were significantly higher than those in the survival group(P<0.05).Multivariate analysis showed that tumor stage,grade of bone destruction,MIP-1αlevel,TRACP-5b level and sclerostin protein level were risk factors for death in patients with multiple myeloma within one year(P<0.05).The serum MIP-1α,TRACP-5b and sclerostin levels had high efficacy in predicting the occurrence of 1 year death in patients with multiple myeloma.The sensitivity of combined detection was 90.0%,specificity was 87.1%,and AUC was 0.934,which was significantly higher than the single indicator,such as MIP-1α(Z=3.068,P=0.002),TRACP-5b(Z=3.622,P<0.001)and sclerostin(Z=2.576,P=0.010),while there was no significant difference in AUC among the three indicators(P>0.05).Conclusion MIP-1α,TRACP-5b and sclerostin are involved in the occurrence and development of multiple myeloma,and have high predictive value in predicting death within 1 year.