多发性骨髓瘤合并肺动脉高压患者临床特征及预后分析

Clinical characteristic and prognosis of patients with multiple myeloma complicated with pulmonary hypertension

目的分析多发性骨髓瘤(MM)合并肺动脉高压(PH)患者的临床特征及预后。方法选取36例MM合并PH患者作为合并PH组,36例单纯MM患者作为MM组。比较两组患者的临床特征、血清指标[脑钠肽(BNP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、血气指标[动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))]和生存情况。采用受试者工作特征(ROC)曲线分析各指标检测对MM合并PH患者预后的预测价值。采用Cox风险比例回归模型分析MM合并PH患者预后的影响因素。结果MM组贫血、肾功能不全、心脏舒张功能不全患者比例均低于合并PH组,差异均有统计学意义(P﹤0.05)。MM组患者BNP、TNF-α、IL-6、PaCO_(2)水平均明显低于合并PH组,PaO_(2)水平明显高于合并PH组,差异均有统计学意义(P﹤0.01)。MM组患者12个月总生存率和无进展生存率分别高于合并PH组,差异均有统计学意义(P﹤0.05)。ROC曲线分析结果显示,BNP[曲线下面积(AUC)=0.822]、TNF-α(AUC=0.701)和IL-6(AUC=0.745)对MM合并PH患者预后的预测价值良好(P﹤0.05)。Cox风险比例回归分析结果显示,贫血、BNP≥4190.770 pg/ml、TNF-α≥251.031 ng/L和IL-6≥25.211 ng/L均为MM合并PH患者预后的独立危险因素(P﹤0.01)。结论合并PH的MM患者与单纯MM患者的临床特征差异较大,预后较差,且贫血、BNP、TNF-α和IL-6水平能够影响MM合并PH患者的预后。

Objective To analyze the clinical characteristic and prognosis of patients with multiple myeloma(MM)complicated with pulmonary hypertension(PH).Method A total of 36 patients with MM complicated with PH were selected as the combined PH group and 36 patients with simple MM were selected as the MM group.The clinical characteristics,serum indexes[brain natriuretic peptide(BNP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],blood gas indexes[arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2))]and survival of the two groups were compared.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each indicator for the prognosis of patients with MM and PH.Cox proportional regression model was used to analyze the influencing factors of prognostic of MM patients complicated with PH.Result The proportions of anemia,renal insufficiency and diastolic dysfunction in MM group were lower than those in combined PH group,and the differences were statistically significant(P<0.05).The levels of BNP,TNF-α,IL-6 and PaCO_(2)in MM group were significantly lower than those in combined PH group,and the level of PaO_(2)was significantly higher than that in combined PH group,the differences were statistically significant(P<0.01).The 12-month overall survival rate and progression-free survival rate in MM group were higher than those in combined PH group,and the differences were statistically significant(P<0.05).ROC curve analysis showed that BNP[area under the curve(AUC)=0.822],TNF-α(AUC=0.701)and IL-6(AUC=0.745)had good predictive value in MM patients complicated with PH(P<0.05).Cox proportional regression analysis showed that anemia,BNP≥4190.770 pg/ml,TNF-α≥251.031 ng/L and IL-6≥25.211 ng/L were independent risk factors for the prognosis of patients with MM and PH(P<0.01).Conclusion The clinical characteristics of MM complicated with PH patients are different from those of MM patients alone,and the prognosis is poor,the anemia and levels of BNP,TNF-αand IL-6 can affect the prognosis of MM patients combined with PH.