白/球蛋白比值对多发性骨髓瘤患者的预后价值

Prognostic Value of Clearance/globulin Ratio in Patients with Multiple Myeloma

目的:探讨血清白/球蛋白比值(A/G)与初诊多发性骨髓瘤(MM)患者临床指标的相关性及对预后的意义。方法:选取2018年1月—2023年4月江南大学附属中心医院血液内科收治的初诊MM患者55例的临床资料(随访至2023年7月),通过受试者操作特征曲线(ROC曲线)分析得出最佳截断值,根据A/G水平分为低比值组(A/G<0.725)和高比值组(A/G≥0.725)。比较两组临床特征的差异,采用Kaplan-Meier曲线分析检测A/G水平的预后价值,采用Cox风险比例模型进行单因素和多因素分析。结果:ROC曲线分析,A/G的最佳截止点为0.725;高比值组和低比值组Ig分型、血红蛋白、白蛋白、肌酐比较,差异有统计学意义(P<0.05);单因素Cox分析显示,血小板计数、A/G水平与多发性骨髓瘤患者OS、PFS有关(P<0.05);多因素Cox分析显示,A/G<0.725是多发性骨髓瘤患者OS、PFS的独立不良预后因素(P<0.05),血小板计数≥100×10^(9)/L是多发性骨髓瘤患者OS的独立不良预后因素(P<0.05)。结论:初诊时A/G比值低下提示预后不良,A/G可能是多发性骨髓瘤患者的一种潜在的预后生物标志物。

Objective:To investigate the correlation between blood clearance/globulin ratio(A/G)and clinical indicators in newly diagnosed multiple myeloma(MM)patients and its prognostic significance.Methods:The clinical data of fifty-five newly diag⁃nosed MM patients admitted to the Department of Hematology of the Central Hospital Affiliated to Jiangnan University from Janu⁃ary 2018 to April 2023(followed up to July 2023)were selected,and the optimal cut-off value was obtained through receiver oper⁃ating characteristic curve(ROC curve)analysis.According to the A/G level,they were divided into low ratio group(A/G<0.725)and high ratio group(A/G≥0.725).The difference of clinical features between the two groups was compared.Kaplan-Meier curve analysis was used to detect the prognostic value of A/G level.Univariate and multivariate analysis was performed by Cox risk pro⁃portional model.Results:ROC curve analysis showed that the optimal cut-off point of A/G was 0.725;Ig classification,hemoglo⁃bin,albumin and creatinine were significantly different between high ratio group and low ratio group(P<0.05);Univariate Cox analysis showed that platelet count and A/G level were correlated with OS and PFS in multiple myeloma patients(P<0.05);Multi⁃variate Cox analysis showed that A/G<0.725 was an independent adverse prognostic factor for OS and PFS in multiple myeloma patients(P<0.05);Platelet count≥100×10^(9)/L was an independent adverse prognostic factor for OS in multiple myeloma patients(P<0.05).Conclusion:A low A/G ratio at initial diagnosis suggests poor prognosis,and A/G may be a potential prognostic biomark⁃er in patients with multiple myeloma.