多发性骨髓瘤相关性肾脏损伤患者尿NAG、NGAL、sFLC水平变化及对预后的预测价值

Changes of Urinary NAG,NGAL and sFLC Levels in Patients with Multiple Myeloma-associated Kidney Injury and Their Prognostic Value

目的分析多发性骨髓瘤相关性肾脏损伤患者尿N-乙酰-β-氨基葡萄糖苷酶(NAG)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、血清游离轻链(sFLC)水平变化及对预后的预测作用。方法选取2018年1月—2021年9月收治的203例多发性骨髓瘤相关性肾脏损伤纳入观察组;选取同期体检的192例健康人群纳入对照组,比较2组尿NAG、NGAL及sFLC水平。随访1年,根据预后情况将患者分为预后良好组181例和预后不良组22例,影响多发性骨髓瘤相关性肾脏损伤患者预后不良的危险因素采用多因素Logistic回归分析。结果观察组尿NAG、NGAL水平明显高于对照组(P<0.01)。κ轻链阳性组sFLC-κ水平和sFLC-κ/λ比值明显高于对照组(P<0.05)。λ轻链阳性组sFLC-λ水平明显高于对照组,sFLC-κ/λ比值低于对照组(P<0.05)。骨髓浆细胞比例及尿NAG、NGAL水平升高,血白蛋白降低,sFLC-κ/λ比值异常是影响多发性骨髓瘤相关性肾脏损伤患者预后不良的独立危险因素(P<0.05,P<0.01)。结论多发性骨髓瘤相关性肾脏损伤患者尿NAG、NGAL水平升高,骨髓浆细胞比例及尿NAG、NGAL水平升高,血白蛋白降低,sFLC-κ/λ比值异常是影响多发性骨髓瘤相关性肾脏损伤患者预后不良的独立危险因素。

Objective To analyze the changes of urinary N-acetyl-β-glucaminoglycosidase(NAG),neutrophil gelatinase associated lipocalin(NGAL)and serum free light chain(sFLC)levels in patients with multiple myeloma-associated kidney injury and their prognostic effects.Methods A total of 203 patients with multiple myeloma-related kidney injury admitted from January 2018 to September 2021 were included in the observation group.A total of 192 healthy people who underwent physical examination during the same period were included in the control group.The levels of urinary NAG,NGAL and sFLC were compared between the two groups.After 1-year follow-up,the patients were divided into a good prognosis group(181 cases)and a poor prognosis group(22 cases)according to the prognosis.Multivariate Logistic regression analysis was used to analyze the risk factors affecting the poor prognosis of patients with multiple myeloma-associated kidney injury.Results Urinary NAG and NGAL levels in observation group were significantly higher than those in control group(P<0.01).The level of sFLC-κand the ratio of sFLC-κ/λinκlight chain positive group were significantly higher than those in control group(P<0.05).The level of sFLC-λinλlight chain positive group was significantly higher than that in control group,and the ratio of sFLC-κ/λwas lower than that in control group(P<0.05).Increased plasma cell proportion in bone marrow,increased urinary NAG and NGAL levels,decreased blood albumin,and abnormal sFLC-κ/λratio were independent risk factors for poor prognosis in patients with multiple myeloma-associated kidney injury(P<0.05,P<0.01).Conclusion Increased urinary NAG and NGAL levels in patients with multiple myeloma-associated kidney injury,increased plasma cell proportion in bone marrow,increased urinary NAG and NGAL levels,decreased blood albumin,and abnormal sFLC-κ/λratio are independent risk factors for poor prognosis in patients with multiple myeloma-associated kidney injury.