多发性骨髓瘤肾功能不全患者血清PCPE1、IGFBP7水平及临床意义研究

Expression of serum PCPE1 and IGFBP7 in multiple myeloma patients with renal insufficiency and their clinical significance

目的分析多发性骨髓瘤(MM)肾功能不全患者血清前胶原C端蛋白酶增强子1(PCPE1)、胰岛素样生长因子结合蛋白7(IGFBP7)水平的变化,并探讨其临床意义。方法回顾性选取2019年2月至2021年2月苏州大学附属常熟医院收治的MM患者116例,检测患者血清PCPE1、IGFBP7水平和肾功能指标。根据患者肾功能分为肾功能不全组42例和肾功能正常组74例。比较两组患者肾功能指标和血清PCPE1、IGFBP7水平;分析MM肾功能不全患者血清PCPE1、IGFBP7水平与肾功能指标的相关性;分析MM患者肾功能不全的危险因素;分析血清PCPE1、IGFBP7对MM患者肾功能不全的预测效能。结果肾功能不全组患者血肌酐、血尿素氮、血尿酸、胱抑素C及血清PCPE1、IGFBP7水平均高于肾功能正常组(均P<0.05),估计的肾小球滤过率(eGFR)低于肾功能正常组(P<0.05)。MM肾功能不全患者血清PCPE1、IGFBP7水平与eGFR均呈负相关(均P<0.05),与血肌酐、血尿素氮、血尿酸及胱抑素C水平均呈正相关(均P<0.05)。高血清PCPE1水平、高血清IGFBP7水平均是MM患者发生肾功能不全的独立危险因素(均P<0.05)。ROC曲线分析显示,血清PCPE1、IGFBP7预测MM患者肾功能不全的AUC分别为0.833、0.806,最佳截断值分别为12.69、163.81μg/L,灵敏度分别为0.752、0.664,特异度分别为0.821、0.823,均有较高的预测效能;而血清PCPE1、IGFBP7联合预测MM患者肾功能不全的AUC高于单独指标预测(均P<0.05),预测效能更高。结论MM肾功能不全患者血清PCPE1、IGFBP7水平升高,且与肾功能不全程度有关,两者联合对MM患者肾功能不全有较高的预测效能。

Objective To investigate the expression of serum procollagen C-endopeptidase enhancer 1(PCPE1)and insulin like growth factor binding protein 7(IGFBP7)in multiple myeloma(MM)patients with renal insufficiency and their clinical significance.Methods A total of 116 MM patients admitted in Changshu Hospital Affiliated to Suzhou University from February 2019 to February 2021 were enrolled.Serum levels of PCPE1,IGFBP7 and renal function indicators were measured in patients.According to the renal function,there were 42 cases in the renal insufficiency group and 74 cases in the normal renal function group.Renal function indicators and serum levels of PCPE1 and IGFBP7 between two groups of patients were compared.The correlation between serum PCPE1,IGFBP7 levels and renal function indicators were analyzed in MM patients with renal insufficiency.The risk factors for renal dysfunction in MM patients were analyzed.The predictive efficacy of serum PCPE1 and IGFBP7 for renal dysfunction in MM patients were analyzed.Results The levels of serum creatinine,blood urea nitrogen,blood uric acid,cystatin C,PCPE1,and IGFBP7 in patients with renal insufficiency were higher than those in the normal renal function group(P<0.05),while eGFR was lower than that in the normal renal function group(P<0.05).The serum levels of PCPE1 and IGFBP7 in MM patients with renal insufficiency were negatively correlated with eGFR(P<0.05),and positively correlated with blood creatinine,blood urea nitrogen,blood uric acid,and cystatin C levels(P<0.05).The increase of serum PCPE1 and IGFBP7 levels were independent risk factors for renal insufficiency.The area under the curve(AUC)of the combination of serum PCPE1 and IGFBP7 levels for predicting renal dysfunction in MM patients was higher than that of single index(P<0.05).Conclusion Serum PCPE1 and IGFBP7 levels are increased in MM patients with renal insufficiency,which is related to the degree of renal insufficiency.The combination of PCPE1 and IGFBP7 has a high predictive value for renal insufficiency in MM patients.