外周血细胞形态变化与新诊断多发性骨髓瘤患者ISS分期的相关性及临床意义

Correlation and clinical significance of morphological changes in peripheral blood cells and ISS staging in newly diagnosed patients with multiple myeloma

目的探讨外周血细胞形态学检查在新诊断多发性骨髓瘤患者中的应用价值及临床意义,以期为临床早期评估病情、预后提供参考。方法选取2019年10月~2022年4月商丘市第一人民医院收治的88例新诊断多发性骨髓瘤患者作为研究对象,入院后均行外周血细胞形态学检查,比较不同国际分期系统分期(ISS)的患者白细胞计数(WBC)、中性粒细胞绝对计数(ANC)、淋巴细胞绝对计数(ALC)、诱导T细胞/抑制T细胞(CD4+/CD8+)及免疫功能指标[Th1/Th2、淋巴细胞银染核仁区(AgNORs)、转化生长因子(TGF-β)],分析外周血细胞形态学指标与ISS分期、免疫功能指标的相关性,随访6个月后,根据复发情况评估预后,比较不同预后患者入院1个月后外周血细胞形态学指标,分析其对多发性骨髓瘤预后预测价值。结果入院时WBC、ANC、TGF-β比较:Ⅲ期>Ⅱ期>Ⅰ期,入院时ALC、CD4+/CD8+、Th1/Th2、AgNORs比较:Ⅲ期<Ⅱ期<Ⅰ期,差异均有统计学意义(P<0.05);入院时WBC、ANC与ISS分期、血清TGF-β呈正相关,与Th1/Th2、AgNORs呈负相关;ALC、CD4+/CD8+与ISS分期、血清TGF-β呈负相关,与Th1/Th2、AgNORs呈正相关(P<0.05);与预后良好患者比较,预后不良患者入院1个月时WBC、ANC较高,ALC、CD4+/CD8+较低,差异有统计学意义(P<0.05);经ROC曲线分析显示,入院1个月后WBC、ANC、ALC、CD4+/CD8+预测多发性骨髓瘤患者预后不良的AUC分别为0.795、0.832、0.856、0.836,各指标联合预测的AUC为0.927。结论外周血细胞形态学检查与多发性骨髓瘤ISS分期密切相关,可为临床早期评估病情、预测预后提供依据。

Objective To investigate the application value and clinical significance of morphological examination of peripheral blood cells in newly diagnosed multiple myeloma patients,in order to provide reference for early clinical assessment of disease and prognosis.Methods A total of 88 patients with newly diagnosed multiple myeloma admitted to the First People's Hospital of Shangqiu City from October 2019 to April 2022 were selected as research subjects,and peripheral blood cell morphology was performed after admission,and white blood cell count(WBC),absolute neutrophil count(ANC),absolute lymphocyte count(ALC),induced T cells/suppressor T cells(CD4+/CD8+)and immune function indexes[Th1/Th2,Lymphocyte silver-stained nucleolar regions(AgNORs)and transforming growth factor(TGF-β)],the correlation between peripheral blood cell morphology indexes and ISS stage and immune function indexes was analyzed,and after 6 months of follow-up,the prognosis was evaluated according to the recurrence,the morphological indexes of peripheral blood cells after 1 month of admission in patients with different prognosis were compared,and the predictive value of peripheral blood cell morphology on the prognosis of multiple myeloma was analyzed.Results Comparison of WBC,ANC,TGF-βat admission:stage III.>II.>I.,ALC,CD4+/CD8+,Th1/Th2,AgNORs at admission:stage III.<II.<stage I,the differences was statistically significant(P<0.05);WBC,ANC and ISS stage and serum TGF-βwere positively correlated at admission,and negatively correlated with Th1/Th2 and AgNORs.ALC,CD4+/CD8+were negatively correlated with ISS stage and serum TGF-β,and positively correlated with Th1/Th2 and AgNORs(P<0.05);compared with patients with good prognosis,WBC and ANC were higher and ALC and CD4+/CD8+were lower,the difference was statistically significant(P<0.05)when patients with poor prognosis were admitted to the hospital for one month;ROC curve analysis showed that WBC,ANC,ALC,CD4+/CD8+The AUCs for the poor prognosis of multiple myeloma patients were 0.795,0.832,0.856 and 0.836,respectively,and the AUC of the combined prediction of all indicators was 0.927.Conclusion Peripheral blood cell morphology is closely related to the ISS stage of multiple myeloma,which provides a basis for early clinical assessment and prediction of prognosis,so as to formulate targeted treatment plans and improve prognosis.