血清铁蛋白、叶酸、维生素B_(12)在硼替佐米联合化疗治疗多发性骨髓瘤中的价值研究

Values of Serum Ferritin,Folic Acid and Vitamin B_(12)in Treatment of Multiple Myeloma with Bortezomib Combined with Chemotherapy

目的:探讨血清铁蛋白、叶酸、维生素B_(12)在硼替佐米联合化疗治疗多发性骨髓瘤(MM)中的价值。方法:回顾性分析宣城市人民医院在2020年1月至2022年8月收治的40例MM患者和同期40例血液科门诊患者的临床资料,全部MM患者采用硼替佐米联合化疗治疗。运用ROC曲线分析血清铁蛋白、叶酸、维生素B_(12)对MM的诊断效能。比较MM患者治疗前后血清铁蛋白、叶酸、维生素B_(12)水平的变化。根据血清铁蛋白、叶酸、维生素B_(12)水平的均值将患者分为高低表达组,对比分析组间患者的生存情况。结果:MM患者治疗前的血清铁蛋白、维生素B_(12)水平明显高于对照组,叶酸明显低于对照组(均P<0.001)。铁蛋白、叶酸、维生素B_(12)诊断MM患者的AUC分别为0.928、0.843、0.867,特异度分别为100%、67.50%、72.50%,敏感度分别为80.00%、95.00%、87.50%。经4个化疗周期后,40例MM患者CR 9例,VGPR 19例,PR 6例,SD 4例,PD 2例。CR组治疗后的铁蛋白、维生素B_(12)水平较治疗前降低,叶酸较治疗前升高(均P<0.05)。铁蛋白、维生素B_(12)低表达组患者的OS均明显优于高表达组,叶酸高表达组患者的OS明显优于低表达组(均P<0.01)。Cox多因素回归分析结果显示,铁蛋白是MM患者预后的独立影响因素(HR=8.850,95%CI:2.267-34.553,P=0.002)。结论:血清铁蛋白、叶酸、维生素B_(12)对MM的诊断和疗效评估均具有一定辅助价值,其中铁蛋白是MM预后的独立影响因素。

Objective:To investigate the value of serum ferritin,folic acid and vitamin B_(12)in the treatment of multiple myeloma(MM)with bortezomib combined with chemotherapy.Methods:Clinical data of 40 MM patients admitted to our hospital from January 2020 to August 2022 and 40 hematology outpatients during the same period were reviewed.All MM patients were treated with bortezomib combined with chemotherapy.The diagnostic efficacy of serum ferritin,folic acid and vitamin B_(12)on MM was analyzed by ROC curve.The changes of serum ferritin,folic acid and vitamin B_(12)in MM patients before and after treatment were compared.According to the mean values of serum ferritin,folic acid and vitamin Br2,patients were divided into high and low expression groups,and the survival of patients between the groups was compared.Results:Before treatment,the levels of serum ferritin and vitamin B_(12)in MM patients were significantly higher than those in control group,while folic acid was lower(all P<0.001).The area under the curve(AUC)of MM patients diagnosed with ferritin,folic acid and vitamin B_(12)were 0.928,0.843 and 0.867,the specificity was 100%,67.50%and 72.50%,and the sensitivity was 80.00%,95.00%and 87.50%,respectively.After 4 cycles of chemotherapy,there were 9 cases of complete remission(CR),19 cases of very good partial remission(VGPR),6 cases of PR,4 cases of stable disease(SD)and 2 cases of progression disease(PD)in 40 MM patients.In CR group,ferritin and vitamin B_(12)decreased but folic acid increased after treatment compared with before treatment(all P<0.05).The overall survival(OS)rates of patients in low expression group of ferritin and vitamin B_(12)were significantly higher than those in high expression group(both P<0.01).The OS rate of patients in high expression group of folic acid was significantly higher than that in low expression group(P<0.01).Cox regression analysis showed that ferritin was an independent prognostic factor for MM patients(HR=8.850,95%CI:2.267--34.553,P=0.002).Conclusion:Serum ferritin,folic acid and vitamin B_(12)have some auxiliary value in the diagnosis and efficacy evaluation of MM,and ferritin is an independent prognostic factor for MM.