不同高密度脂蛋白胆固醇水平多发性骨髓瘤患者的临床病理特征及预后分析

Analysis of Clinicopathologic Features and Prognosis of Multiple Myeloma Patients with Different High-density Lipoprotein Cholesterol Levels

目的探讨不同高密度脂蛋白胆固醇(HDL-C)水平多发性骨髓瘤(MM)患者的临床病理特征及预后。方法纳入2017年1月至2020年12月西南医科大学附属医院血液内科收治的133例初诊MM患者作为MM组,选取同期92例健康体检者作为健康对照组,分析两组HDL-C水平的差异;并根据HDL-C中位数水平将MM组患者分为高HDL-C组和低HDL-C组,比较两组患者临床病理特征和总生存时间的差异。结果MM组HDL-C水平低于健康对照组[(0.97±0.42)mmol/L比(1.28±0.30)mmol/L](P<0.01)。133例MM患者HDL-C中位数为0.9 mmol/L,其中高HDL-C(HDL-C>0.9 mmol/L)组62例,低HDL-C(HDL-C≤0.9 mmol/L)组71例。在国际分期系统(ISS)分期中,Ⅲ期和Ⅱ期MM患者HDL-C水平均低于Ⅰ期MM患者[(0.87±0.33)mmol/L、(1.01±0.46)mmol/L比(1.26±0.53)mmol/L](P<0.05),但Ⅲ期与Ⅱ期MM患者HDL-C水平比较差异无统计学意义(P>0.05)。两组不同ISS分期分布比较差异有统计学意义(P<0.01),低HDL-C组血红蛋白<90 g/L、白蛋白<35 g/L、M蛋白定量≥30%、骨髓活检浆细胞比例≥70%、球蛋白≥40 g/L、β2微球蛋白≥7μg/L的比例显著高于高HDL-C组(P<0.05或P<0.01),而总胆固醇、LDL-C、载脂蛋白(Apo)A1、ApoB水平显著低于高HDL-C组(P<0.01)多元Logistic回归分析结果显示,血红蛋白<90 g/L是MM患者合并低HDL-C的独立危险因素(P<0.05)。Kaplan-Meier生存曲线显示,高HDL-C组MM患者总生存时间明显长于低HDL-C组患者(P<0.05)。结论MM患者HDL-C水平普遍下降,高HDL-C组MM患者的总生存时间较低HDL-C组明显延长,HDL-C可反映MM患者的肿瘤负荷及病情进展,有助于判断预后。

Objective To investigate the clinicopathologic features and prognosis of multiple myeloma(MM)patients with different high-density lipoprotein cholesterol(HDL-C)levels.Methods A total of 133 newly diagnosed MM patients admitted to the Department of Hematology of Affiliated Hospital of Southwest Medical University from Jan.1st,2017 to Dec.31st,2020 were enrolled as an MM group,and 92 healthy people for health check-up during the same period were included as a control group to analyze the difference of HDL-C level between the two groups.According to the median HDL-C level,the patients in the MM group were divided into a high HDL-C group and a low HDL-C group,and their clinical data were collected to compare the clinicopathological features and overall survival time between the two groups.Results The HDL-C level in MM group was lower than that in healthy control group[(0.97±0.42)mmol/L vs(1.28±0.30)mmol/L](P<0.01).The median HDL-C of 133 MM patients was 0.9 mmol/L,including 62 patients in the high HDL-C group(HDL-C>0.9 mmol/L)and 71 patients in the low HDL-C group(HDL-C≤0.9 mmol/L).In internationl staging system(ISS)stage,HDL-C levels in stageⅢandⅡMM patients were lower than those in stagesⅠMM patients[(0.87±0.33)mmol/L,(1.01±0.46)mmol/L vs(1.26±0.53)mmol/L](P<0.05).However there was no significant difference in HDL-C level between stageⅢandⅡpatients(P>0.05).There were statistically significant differences in ISS staging between the two groups(P<0.05 or P<0.01).The proportions of hemoglobin<90 g/L,albumin<35 g/L,M protein≥30%,the proportions of plasma cells≥70%,globulin≥40 g/L andβ2 microglobulin≥7μg/L in the low HDL-C group were significantly higher than those in the high HDL-C group(P<0.01).The levels of total cholesterol,LDL-C,apolipoprotein(Apo)A1 and ApoB in bone marrow biopsy were significantly lower than those in high HDL-C group(P<0.01).Multivariate Logistic regression analysis showed that hemoglobin<90 g/L was an independent risk factor for low HDL-C in MM patients(P<0.05).Kaplan-Meier survival curve showed that the overall survival time of MM patients in the high HDL-C group was significantly longer than that in the low HDL-C group(P<0.05).Conclusion The level of HDL-C in MM patients generally decreases,and the total survival time of MM patients in the high HLD-C group is significantly longer than that in the low HDL-C group.HLD-C can reflect the tumor load and disease progression of MM patients,and help to judge the prognosis.