Hcy、β2-MG和造血评分系统与多发性骨髓瘤患者预后的关系及预测价值

Relationship of Hcy,β2-MG and hematopoietic score system and prognosis in patients with multiple myeloma

目的:分析同型半胱氨酸(Hcy)、β2微球蛋白(β2-MG)和造血评分系统与多发性骨髓瘤(multiple myeloma,MM)患者预后的关系及预测价值。方法:选取2017年1月—2020年2月医院收治的100例MM患者,随访3年后依据患者存活情况分为存活组(66例)和死亡组(34例),依据国际分期系统(international staging system,ISS)将患者分为ISSⅠ期组(35例)、ISSⅡ期组(30例)与ISSⅢ期组(35例)。比较不同预后组和不同ISS分期患者Hcy、β2-MG及造血评分系统。结果:存活组与死亡组性别、体重指数(BMI)、是否合并高血压、是否合并糖尿病、吸烟史、饮酒史、骨髓浆细胞、血红蛋白(Hb)、血钙(Ca)、血肌酐(Scr)水平比较,差异无统计学意义(P>0.05),存活组年龄低于死亡组(P<0.05);ISSⅠ期组血清Hcy、β2-MG低于ISSⅡ期组、ISSⅢ期组(P<0.05),ISSⅡ期组Hcy、β2-MG低于ISSⅢ期组(P<0.05),ISSⅠ期组造血评分系统≥1.5分比例低于ISSⅡ期组、ISSⅢ期组(P<0.05),ISSⅡ期组造血评分系统≥1.5分比例低于ISSⅢ期组(P<0.05);存活组血清Hcy、β2-MG低于死亡组(P<0.05),存活组造血评分系统≥1.5分比例低于死亡组患者(P<0.05);进行logistic回归分析:年龄、Hcy、β2-MG、造血评分系统是MM患者预后不良的影响因素(P<0.05);Hcy、β2-MG、造血评分系统单独预测MM患者预后的受试者工作特征曲线(ROC)下面积(AUC)分别为0.883(0.807~0.959)、0.887(0.822~0.951)、0.762(0.702~0.865),灵敏度分别为0.852、0.867、0.895,特异度分别为0.855、0.830、0.816,Hcy、β2-MG、造血评分系统联合预测MM患者预后的ROC曲线下面积为0.928(0.877~0.979),灵敏度为0.908,特异度为0.810。结论:MM预后与患者血清Hcy、β2-MG水平及造血评分系统密切相关,Hcy、β2-MG和造血评分系统联合预测MM预后比单独预测价值更高。

Objective To analyse the relationship between Hcy,β2-microglobulin(β2-MG)and the hematopoietic scoring system and the prognosis of patients with multiple myeloma(MM)patients,and evaluate the value of predicting the prognosis with them.Methods The 100 patients with multiple myeloma admitted to the hospital from January 2017 to February 2020 were divided into survival group(66 patients)and death group(34 patients),and into ISSⅠ(35 patients),ISSⅡ(30 patients)and ISSⅢ(35 patients)according to the international staging system(ISS).The general data of patients including Hcy,β2-MG and the hematopoietic scoring systems were compared in different prognosis groups,and Hcy,β2-MG and the hematopoietic scoring systems were compared in different prognosis groups,and patients with different ISS stages.Results The comparsion of the group with good prognosis and the group with poor prognosis in gender,body mass index(BMI),hypertension,diabetes,smoking history,alcohol history,bone marrow plasma cells,hemoglobin(Hb),blood calcium(Ca)and blood creatinine(Scr)level was not statistically different(P>0.05).The age of the group with good prognosis was lower than the group with poor prognosis(P<0.05).The Hcy andβ2-MG in serum of ISS stageⅠgroup was lower than those of ISS stageⅡgroup and ISS stageⅢgroup(P<0.05).The Hcy andβ2-MG in serum of ISS stageⅡgroup was lower than those of ISS stageⅢgroup(P<0.05).The proportion of score≥1.5 of ISSⅠwas lower than that of ISSⅡand ISSⅢ(P<0.05).The proportion of score≥1.5 of ISSⅡwas lower than that in the ISSⅢ(P<0.05).The Hcy andβ2-MG in the survival group was lower than those of the death group(P<0.05),the proportion of score≥1.5 in the survival group was lower than that in the death group(P<0.05).Logistic regression analysis showed that age,Hcy,β2-MG and the hematopoietic scoring system were the factors affecting the poor prognosis in patients with multiple myeloma(P<0.05).The area under the ROC curve for Hcy,β2-MG and the hematopoietic scoring system alone predicting the prognosis of patients with multiple myeloma were 0.883(0.807-0.959),0.887(0.822-0.951),0.762(0.702-0.865),the sensitivities were 0.852,0.867,and 0.895,the specificities were 0.855,0.830,and 0.816,respectively.The area under the ROC curve of the Hcy,β2-MG and the hematopoietic scoring system combined to predict the prognosis of patients with multiple myeloma was 0.928(0.877-0.979),the sensitivity was 0.908,and the specificity level was 0.810.Conclusion The prognosis of multiple myeloma might be closely related to serum Hcy,β2-MG level and hematopoietic scoring system,and the combination of Hcy,β2-MG and hematopoietic scoring system might have higher prediction value than alone.