相关临床指标在初诊多发性骨髓瘤中的预测价值

The predictive value of related clinical markers in newly diagnosed multiple myeloma

目的:评估初诊多发性骨髓瘤(multiple myeloma,MM)患者中性粒细胞与淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、血清游离轻链比值(serum free light chain ratio,rFLC)、β2微球蛋白(β2-microglobulin,β2-MG)、乳酸脱氢酶(lactate dehydrogenase,LDH)、铁蛋白(serum ferritin,SF)、白蛋白(albumin,ALB)、血红蛋白(hemoglobin,Hb)、血尿酸(uric acid,UA)、血钙(serum calcium,Ca)等临床指标对不同临床分期分组及不同转归的预测价值。方法:收集南通大学第二附属医院2018年1月—2020年1月有rFLC检测记录的初诊MM患者58例的临床资料,对患者进行国际分期系统(International Staging System,ISS)分期,根据有无肾功能损害分为A组与B组;有无髓外病变分为无髓外病变组与髓外病变组;4次诱导治疗后患者分为完全缓解(complete response,CR)组与非CR组;比较不同ISS分期及不同分组各临床指标的差异,采用Pearson相关分析各临床指标间的相关性,采用多因素二元Logistic回归分析进行危险因素分析,采用ROC曲线与AUC来确定各指标的预测价值。结果:MM患者NLR明显高于对照组(P<0.05);不同ISS分期患者NLR、rFLC、β2-MG、LDH、ALB水平差异有统计学意义(P<0.05);B组、非CR组、髓外病变组患者NLR、rFLC、β2-MG、LDH水平均高于对照组(均P<0.05),ALB水平均低于对照组(P<0.05);多因素二元Logistic回归分析提示LDH、rFLC、NLR、β2-MG是初诊MM患者发生肾功能损害、诱导治疗无CR、髓外病变的独立危险因素。结论:对于初治MM患者,高水平LDH、rFLC、NLR、β2-MG水平提示预后不良,与ISS分期晚,易于发生髓外病变、合并肾功能损害及诱导治疗不易获得CR密切相关。

Objective:To evaluate the prognostic value of neutrophil/lymphocyte ratio(NLR),serum free light chain ratio(rFLC),β2-microglobulin(β2-MG),lactate dehydrogenase(LDH),serum ferritin(SF),albumin(ALB),hemoglobin(Hb),uric acid(UA),serum calcium(Ca)in newly diagnosed patients with multiple myeloma(MM).Methods:Clinical data of 58 cases of newly diagnosed MM patients with rFLC test records referred to the Second Affiliated Hospital of Nantong University from January 2018 to January 2020 were collected.All patients are divided according to International Staging System(ISS)staging,and were divided into group A and group B according to the renal function damage.Patients with or without medullary lesions were divided into non-extramedullary lesions group and extramedullary lesions group.Treatment response was assessed after four induction treatments,then patients were divided into complate response(CR)group and non-CR group.Compare clinical indicators in different ISS stages and different groups,using Pearson correlation analysis the correlation among the various clinical indicators,Logistic regression was used to analyze the correlation between each factor to identify risk factors,using the ROC to determine the predictive value of each indicators.Results:The NLR of MM patients was significantly higher than that of control group(P<0.05).The differences of NLR,rFLC,β2-MG,LDH and ALB of patients with different ISS stages were statistically significant(P<0.05).The NLR,rFLC,β2-MG and LDH levels in group B,non-CR group and extramedullary disease group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05),while the albumin levels were all decreased(P<0.05).Multivariate binary Logistic regression analysis suggested that LDH,rFLC,NLR,β2-MG were independent risk factors for renal function damage,no CR in induction therapy,and extramedullary lesions in MM patients with initial diagnosis.Conclusion:For newly diagnosed MM patients,high LDH,rFLC,NLR,β2-MG levels suggest poor prognosis,and are closely related to ISS staging,susceptibility to extramedullary lesions,renal impairment,and difficulty in obtaining CR through induction therapy.