初诊多发性骨髓瘤患者外周血中性粒细胞/淋巴细胞的比值对预后分层的价值

The value of peripheral blood neutrophil/lymphocyte ratio among newly diagnosed multiple myeloma patients in prognostic stratification

目的探究初诊多发性骨髓瘤(multiple myeloma,MM)患者外周血中性粒细胞/淋巴细胞的比值(NLR)对初诊MM患者预后分层的价值。方法选择2011年12月—2021年12月本院收治的MM患者200例作为研究对象,并将其设置为研究组,收集MM患者的基本资料,如:肌酐、血红蛋白、中性粒细胞计数、淋巴细胞计数,D-S分期、ISS分期等。同时将同期本院体检科开展体检的110名健康人群作为参照组。比较两组人群的NLR水平是否有差异,利用ROC曲线确定敏感度、特异性,计算出研究组患者NLR的截断值,随后将200例MM患者按照NLR数值分成高NLR组和低NLR组,比较两组无进展生存(PFS)、总生存时间(OS)。结果初诊MM患者与健康人群在NLR水平方面存在明显的统计学差异,初诊MM患者NLR水平高于健康人群(P<0.05)。研究组外周血NLR的最优截断值为4,根据是否>4分为两个亚组,即低NLR组141例患者(NLR≤4组)、高NLR组59例患者(NLR>4组),高NLR组的初诊MM患者较低NLR组的初诊MM患者存在明显贫血、血小板减少、髓外浸润等问题(P<0.05)。根据生存曲线可知NLR>4的初诊MM患者PFS、OS中位时间较NLR≤4的初诊MM患者低(P<0.05)。结论高NLR提示初诊MM患者预后不良,这表明除D-S分期、ISS分期外,还可将外周血NLR水平作为预测初诊MM患者预后分层的指标。

Objective To explore the value of peripheral blood neutrophil to lymphocyte ratio(NLR)in newly diagnosed multiple myeloma(MM)patients in prognostic stratification.Methods A total of 200 MM patients those were treated in the hospital from December 2011 to December 2021 were selected as the research object and were set as the research group.The basic data of MM patients such as creatinine,hemoglobin,neutrophil count,lymphocyte count,D-S stage,ISS stage,were collected.During the same period,110 healthy people who underwent physical examination in the department of physical examination of our hospital were selected as the reference group.The differences of NLR were compared from the two groups.ROC curve was used to determine the sensitivity and specificity,and calculate the cut-off of NLR.Then 200 MM patients were divided into two subgroups of high NRL group and low NRL group according to the value of NRL.The progression-free survival(PFS)and overall survival time(OS)of MM patients were compared between the two groups.Results There was a significant difference in NLR level between newly diagnosed MM patients and healthy people.The NLR level of newly diagnosed MM patients was significantly higher than that of healthy people(P<0.05).The best cut-off value of NRL in research group was 4,and the 200 MM patients were divided into two subgroups according to whether the NLR value was over 4,namely,141 patients in the low NLR group(NLR≤4 group)and 59 patients in the high NLR group(NLR>4 group).The newly diagnosed MM patients in the high NLR group had obvious anemia,thrombocytopenia,extramedullary infiltration and other problems compared with those in the low NLR group(P<0.05).According to the survival curve,the median time of PFS and OS in newly diagnosed MM patients with NLR>4 was lower than that in newly diagnosed MM patients with NLR≤4(P<0.05).Conclusions High NLR indicates poor prognosis of newly diagnosed MM patients,which indicates that in addition to D-S stage and ISS stage,peripheral blood NLR level can also be used as an indicator to predict prognosis stratification of newly diagnosed MM patients.