外周血中NLR、MLR及PLR对多发性骨髓瘤患者预后的影响

Influence of peripheral blood NLR,MLR and PLR in prognosis of patients with multiple myeloma

目的探讨外周血中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)及血小板与淋巴细胞比值(PLR)对多发性骨髓瘤(MM)患者预后的影响。方法选取2019年1月至2023年5月贵州医科大学附属医院收治的159例初发MM患者为研究对象。收集患者初次治疗前的一般资料、血液生化和骨髓常规结果,计算NLR、MLR和PLR。采用单因素和多因素Cox回归模型分析影响因素,受试者工作特征(ROC)曲线分析相关指标的预测价值,Kaplan-Meier生存曲线和Log-Rank检验进行生存分析。结果ROC曲线分析显示,NLR的临界值为2.682、MLR的临界值为0.317、PLR的临界值为147.786,将患者分为高/低NLR组(n=61,n=98)、高/低MLR组(n=76,n=83)、高/低PLR组(n=59,n=100)。与高NLR组比较,低NLR组血钙<2.5 mmol/L及肌酐<177μmmol/L时所占比例较高(P<0.05);低MLR组和高MLR组不同血钙、肌酐及DS分期比较差异有统计学意义(P<0.05);低PLR组和高PLR组血钙比较差异有统计学意义(P<0.05)。3个疗程后,高NLR组、高MLR组及高PLR组完全缓解率均明显低于相应低组别(P<0.05)。多因素Cox回归分析结果显示,血红蛋白<100 g/L、高PLR是影响MM患者无进展生存(PFS)的独立危险因素(P<0.05),年龄>60岁是影响MM患者总生存(OS)的独立危险因素(P<0.05)。结论NLR、MLR、PLR可以作为辅助工具评估MM患者的预后。

Objective To investigate the influence of peripheral blood neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR)and platelet-to-lymphocyte ratio(PLR)on the prognosis in the patients with multiple myeloma(MM).Methods A total of 159 newly diagnosed MM admitted and treated in the Affiliated Hospital of Guizhou Medical University from January 2019 to May 2023 were selected as the study subjects.The general clinical data,blood biochemical and marrow routine detection results before the initial treatment were collected.NLR,MLR and PLR were calculated.The univariate and multivariate Cox-regression model was adopted to analyze the influencing factors.The receiver operating characteristic(ROC)curve was used to analyze the predictive value.The Kaplan-Meier survival curve and Log-Rank test were used to conduct the survival analysis.Results The ROC curve showed that the critical values of NLR,MLR and PLR were 2.682,0.317 and 147.786 respectively.The patients were divided into the high/low NLR groups(n=61,n=98),high/low MLR group(n=76,n=83)and high/low PLR groups(n=59,n=100).The proportions of blood calcium<2.5 mmol/L and creatinine<177μmmol/L in the low NLR group in the low NLR group were higher compared with the high NLR group(P<0.05);the blood calcium,creatinine and DS stage had statistical differences between the low MLR group and high MLR group(P<0.05);blood calcium had statistical difference between the low PLR group and high PLR group(P<0.05).After 3 treatment courses,the complete remission rate in the high NLR group,high MLR group and high PLR group was significantly lower than that in the corresponding low group(P<0.05).The multivariate Cox-regression analysis results showed that hemoglobin<100 g/L and high PLR were the independent risk factors affecting the progress free survival(PFS)stage in the patients with MM(P<0.05).The age>60 years old was the independent risk factors affecting the overall survival(OS)in the patients with MM(P<0.05).Conclusion NLR,MLR and PLR could serve as the assisted tool to evaluate the prognosis in the patients with MM.