血清β2-MG、sRAGE联合PNI对初治多发性骨髓瘤患者死亡的预测价值

Predictive Value of Serum β2-MG,sRAGE Combined with PNI for Death in Patients with Primary Treatment Multiple Myeloma

目的:探讨血清β2-微球蛋白(β2-MG)、可溶性晚期糖基化终末产物受体(sRAGE)联合预后营养指数(PNI)对初治多发性骨髓瘤(MM)患者死亡的预测价值。方法:选取2018年1月至2020年1月马鞍山市人民医院收治的80例初次诊断MM患者,治疗前检测所有患者血清β2-MG、sRAGE、白蛋白和外周血淋巴细胞计数水平,并计算PNI。出院后随访24个月,记录随访期间MM患者存活情况,分析影响MM患者出院24个月死亡的危险因素以及β2-MG、sRAGE、PNI联合预测MM患者出院后24个月内死亡的临床价值。结果:随访期间失访1例,死亡24例,生存55例。死亡组血清β2-MG水平高于生存组(P<0.05),血清s RAGE水平和PNI低于生存组(P<0.05)。R-ISSⅢ期、β2-MG水平升高是MM患者出院后24个月内死亡的危险因素(P<0.05),sRAGE水平和PNI升高是其保护因素(P<0.05)。β2-MG、sRAGE、PNI预测MM患者出院后24个月内死亡的曲线下面积分别为0.776、0.720、0.717,联合三项指标预测MM患者出院后24个月内死亡的曲线下面积达0.890,高于单独指标预测。结论:MM患者血清β2-MG水平增高、sRAGE水平和PNI降低与出院后24个月内死亡有关,联合β2-MG、sRAGE、PNI可有效辅助评估MM患者预后。

Objective:To investigate the predictive value of serumβ2-microglobulin(β2-MG),soluble receptor for advanced glycation end-products(sRAGE)combined with prognostic nutrition index(PNI)for death in patients with primary treatment multiple myeloma(MM).Methods:80 patients with MM initially diagnosed in Maanshan People's Hospital from January 2018 to January 2020 were selected.Serumβ2-MG,sRAGE,albumin and peripheral blood lymphocyte count levels of all patients were detected before treatment,and PNI was calculated.The survival of patients with MM was recorded during the follow-up period of 24 months after discharge.The risk factors affecting the death of patients with MM at 24 months after discharge were analyzed and the clinical value ofβ2-MG,sRAGE and PNI combined in predicting the death of patients with MM at 24 months after discharge was analyzed.Results:During the follow-up period,1 case was lost to follow-up,24 cases died,and 55 cases survived.The serumβ2-MG level in the death group was higher than that in the survival group(P<0.05),and the serum sRAGE level and PNI were lower than those in the survival group(P<0.05).R-ISSⅢand increasedβ2-MG levels were risk factors for death in patients with MM within 24 months after discharge(P<0.05),and increased sRAGE level and PNI were protective factors(P<0.05).The area under curve ofβ2-MG,sRAGE and PNI predicting the death of patients with MM within 24 months after discharge were 0.776,0.720 and 0.717,respectively.The area under curve of combining three indicators predicting the death of patients with MM within 24 months after discharge was 0.890,which was higher than that predicted by individual indicators.Conclusion:Increased serumβ2-MG level and decreased sRAGE level and PNI in patients with MM are associated with death within 24 months after discharge.The combination ofβ2-MG,sRAGE and PNI could effectively assist in evaluating the prognosis of patients with MM.