多发性骨髓瘤患者凝血指标水平及预后意义的探究

Study on the Level of Coagulation Index and its Prognostic Significance in Patients with Multiple Myeloma

目的研究分析多发性骨髓瘤(MM)患者凝血指标水平及预后关系。方法本次研究的开展时间在2019年4月至2022年8月,将在上述时间段内我院收治的MM患者作为研究对象,纳入至研究的患者共计50例,所有患者均需要进行实验室指标检测,包括了血浆凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血酶时间(APTT)、凝血活酶时间(TT)、血小板(PLT)、D-二聚体(D-D)等指标水平。对各项凝血指标水平与MM患者的预后相关性展开分析。结果在MM患者中,患者的年龄、疾病分型、分期以及β_(2)-MG等与凝血指标有着相关性,其中与凝血指标水平呈正相关的有β_(2)-MG和疾病分期,即为MM患者的分期越晚、β_(2)-MG处于较高水平时,IgA和IgG男性患者的发生凝血紊乱的风险更高,APTT、PT和FIB指标均是男性患者高于女性患者,APTT、PT指标水平比较,轻链组要明显低于IgA组、IgG组,并且这两项指标水平患者的分期越晚,水平呈现出增长趋势,而D-D水平轻链组则要显著高于IgA组、IgG组,MM死亡患者的凝血指标水平要明显高于存活患者,β_(2)-MG水平越高的患者,其D-D水平也明显更高,而PLT水平则更低,差异有统计学意义(P<0.05);在年龄较大、血糖、ALB以及骨髓浆细胞比例偏高的患者中APTT、PT延长,但数值差异并不明显,差异无统计学意义(P>0.05)。对各项凝血指标进行单因素和多因素分析,结果显示,PT、FIB、ALB、APTT是影响MM患者预后的因素,其中PT、FIB为独立影响因素。结论在多发性骨髓瘤患者中,凝血功能与多项临床指标之间有着较高的相关性,并且在患者的预后检测中有着非常重要的作用。

Objective To study and analyze the level of blood coagulation indicators and the prognosis of patients with multiple myeloma(MM).Methods The study was carried out from April 2019 to August 2022. The patients with MM admitted in our hospital during the above period were taken as the subjects of the study. A total of 50 patients were included in the study. All patients needed laboratory tests, including plasma prothrombin time(PT), fibrinogen(FIB), activated partial thrombin time(APTT), thromboplastin time(TT), platelet(PLT) D-dimer(D-D) and other indicators. The correlation between the levels of coagulation indexes and the prognosis of MM patients was analyzed. Results Among MM patients, the age, disease type, stage and β 2-MG is related to coagulation indexes, among which, the positive correlation is β_(2)-MG and disease stage, that is, the later the stage of MM patients β_(2)-MG is at a higher level, male patients with IgA and IgG have a higher risk of blood coagulation disorder. The APTT, PT and FIB indicators of male patients are higher than those of female patients. Compared with the APTT and PT indicators, the light chain group is significantly lower than the IgA group and the IgG group. The later the stage of the patients with these two indicators is, the higher the level is. Compared with the D-D indicators, the light chain group is significantly higher than the IgA group and the IgG group. The level of coagulation index in MM dead patients was significantly higher than that in survivors, β The higher the 2-MG level, the higher the D-D level, and the lower the PLT level. The difference was statistically significant(P<0.05). APTT and PT were prolonged in older patients with higher proportion of blood glucose, ALB and bone marrow plasma cells, but the difference was not significant, and the difference was not statistically significant(P>0.05);PT, FIB, ALB and APTT were the prognostic factors of MM patients, among which PT, FIB was an independent factor. Conclusion In patients with multiple myeloma, there is a high correlation between coagulation function and a number of clinical indicators, and it plays a very important role in the prognosis of patients.