中性粒细胞/淋巴细胞比值对多发性骨髓瘤患者预后评估的价值

The prognostic value of neutrophil / lymphocyte ratio in patients with multiple myeloma

目的:探讨中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)对多发性骨髓瘤(multiple myeloma,MM)患者预后评估的价值。方法:收集127例MM患者初诊时相关临床数据,按NLR 1.87为界,分为低NLR组57例和高NLR组70例。比较两组临床特征,对影响多发性骨髓瘤患者预后的因素进行单因素分析和Cox回归模型多因素分析。结果:127例患者3年及5年总生存期(overall survival,OS)分别为65%、38%,3年及5年无进展生存期(progression-free survival,PFS)分别为34%、22%。与低NLR组比较,高NLR组患者初诊时血清白蛋白<36 g/L、β_(2)微球蛋白>2.4μg/mL、血钙>2.1 mmol/L、国际分期系统(international staging system,ISS)分期晚、Durie-Salmon(DS)分期晚的患者比例显著增高,差异均具有统计学意义(P<0.05)。单因素分析显示,年龄>60岁、NLR>1.87、血红蛋白<90 g/L、白蛋白<36 g/L、乳酸脱氢酶>245 U/L、β_(2)微球蛋白>2.4μg/mL、骨髓瘤细胞比例>30%为影响OS的不良因素(P<0.05);年龄>60岁、NLR>1.87、血小板计数<125×10^(9)/L、血红蛋白<90 g/L、白蛋白<36 g/L、乳酸脱氢酶>245 U/L、β_(2)微球蛋白>2.4μg/mL、骨髓瘤细胞比例>30%、ISS分期、DS分期为影响PFS的不良因素(P<0.05)。COX多因素分析表明,年龄>60岁、NLR>1.87、乳酸脱氢酶>245 U/L、骨髓瘤细胞比例>30%是影响OS的独立危险因素,年龄>60岁、NLR>1.87、血小板计数<125×10^(9)/L、白蛋白<36 g/L、乳酸脱氢酶>245 U/L、骨髓瘤细胞比例>30%是影响PFS的独立危险因素。结论:NLR升高与MM患者预后不良的临床特征相关,是影响患者生存的独立危险因素,可作为预测MM患者预后的容易获得的指标。

Objective:To investigate the value of neutrophil/lymphocytic ratio(NLR)in evaluating the prognosis of patients with multiple myeloma(MM).Methods:The relevant clinical data of 127 patients with MM were collected at initial diagnosis.According to NLR 1.87,there were 57 cases in the low NLR group and 70 cases in the high NLR group.The clinical features of the two groups were compared,and the factors influencing the prognosis of MM patients were analyzed by univariate analysis and multivariate analysis of Cox regression model.Results:The 3-year and 5-year overall survival(OS)of the patients were 65%and 38%respectively,and the 3-year and 5-year progression-free survival(PFS)were 34%and 22%respectively.Compared with the low NLR group,the proportion of patients with serum albumin<36 g/L,β_(2) microglobulin>2.4μg/mL,calcium>2.1 mmol/L,late international staging system(ISS)stage and Durie-Salmon(DS)stage was higher than that in the high NLR group at initial diagnosis,and the difference was statistically significant(P<0.05).Univariate analysis showed that age >60 years old, NLR>1.87, hemoglobin <90 g/L, albumin <36 g/L, lactate dehydrogenase >245 U/L, β_(2) microglobulin >2.4 μg/mL and myeloma cell ratio >30% were the adverse factors affecting OS (P<0.05);age >60 years old, NLR >1.87, platelet count <125×10^(9)/L, hemoglobin <90 g/L, albumin <36 g/L, lactate dehydrogenase >245 U/L, β_(2) microglobulin >2.4 μg/mL, proportion of myeloma cells >30%, ISS stage and DS stage were the adverse factors affecting PFS (P<0.05). COX multivariate analysis showed that age >60 years old, NLR>1.87, lactate dehydrogenase >245 U/L and myeloma cell ratio >30% were the independent risk factors affecting OS. Age >60 years old, NLR>1.87, platelet count <125×10^(9)/L, albumin <36 g/L, lactate dehydrogenase >245 U/L and myeloma cell proportion >30% were the independent risk factors affecting PFS. Conclusion: The increase of NLR is associated with the clinical characteristics of poor prognosis in MM patients, which is an independent risk factor affecting patient survival and can be used as an easy indicator to predict the prognosis of MM patients.