炎症-营养指标对新诊断多发性骨髓瘤患者预后和早期死亡的预测作用

The role of inflammatory-nutritional indicators in predicting the prognosis and early mortality of newly diagnosed multiple myeloma patients

目的探讨炎症-营养指标对新诊断多发性骨髓瘤(newly diagnosed multiple myeloma,NDMM)患者的预后及早期死亡的预测作用。方法回顾性分析2015年8月至2022年2月在徐州医科大学附属医院初次诊断的161例NDMM患者的临床资料,包括年龄、性别、血红蛋白、白蛋白、乳酸脱氢酶(LDH)、血肌酐、血β2-微球蛋白、肿瘤负荷、浆细胞表面的CD27及CD56表达、荧光原位杂交检测细胞遗传学结果、是否合并髓外病变、是否合并脾大、预后营养指数(PNI)、炎症指标单核-淋巴细胞比值(MLR)、系统性免疫炎症指数以及治疗方案。对初诊时基线特征及治疗方案进行单因素及多因素Cox比例风险回归分析探索影响预后的因素,采用单因素及多因素logistic回归方法分析影响早期死亡的因素。结果单因素Cox回归分析显示,血红蛋白、LDH、PNI、MLR、CD27是影响患者无进展生存时间的因素(P<0.05);年龄、LDH、PNI、MLR、CD27、CD56是影响患者总生存时间的因素(P<0.05)。多因素Cox回归分析显示,高LDH、高MLR、CD27阴性是影响无进展生存时间的独立危险因素(P<0.05);年龄≥65岁、高LDH、低PNI、高MLR、1q21扩增阳性是影响总生存时间的独立危险因素(P<0.05)。12个月内死亡和24个月内死亡的发生率分别为11.5%和24.2%。年龄≥65岁、浆细胞表面CD56阴性是12个月内死亡和24个月内死亡的独立影响因素;高LDH是12个月内死亡的独立影响因素;高MLR、低PNI是24个月内死亡的独立影响因素(均P<0.05)。结论低PNI、高MLR是影响NDMM患者预后的独立不良因素,可能预示患者早期死亡的风险增加。

Objective To investigate the prognostic role of inflammation-nutrition indicators in predicting the prognosis and early mortality of newly diagnosed multiple myeloma(NDMM)patients.Methods The clinical data of 161 patients with NDMM from August 2015 to February 2022 at the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.The clinical data included age,gender,hemoglobin,albumin,lactate dehydrogenase(LDH),creatinine,bloodβ2-microglobulin,tumor burden,CD27 and CD56 expression on plasma cell surface,cytogenetics detecting by fluorescence in situ hybridization,presence of extramedullary disease,splenomegaly,prognostic nutritional index(PNI),inflammation indicators monocyte-lymphocyte ratio(MLR),systemic immune inflammation index,and treatment regimens.Single-factor and multi-factor Cox proportional hazards regression analyses were conducted on baseline characteristics at initial diagnosis and treatment regimens to explore factors influencing prognosis;single-factor and multi-factor logistic regression methods were used to analyze factors affecting early mortality.Results Univariate Cox regression analysis showed that hemoglobin,LDH,PNI,MLR,and CD27 were factors affecting patients'progression-free survival(P<0.05);age,LDH,PNI,MLR,CD27 and CD56 were factors affecting patients'overall survival(P<0.05).Multivariate Cox regression analysis showed that high LDH,high MLR,and plasma cell surface CD27 negativity were independent risk factors affecting progression-free survival;age≥65 years,high LDH,low PNI,high MLR,and 1q21 amplification were independent adverse prognostic factors affecting overall survival(P<0.05).The occurrence rates of death within 12 months(EM12)and 24 months(EM24)were 11.5%and 24.2%,respectively.Age≥65 years and plasma cell surface CD56 negativity were independent factors for both EM12 and EM24;high LDH was an independent factor for EM12;high MLR and low PNI were independent factors for EM24(P<0.05).Conclusion Low PNI and high MLR are independent risk factors affecting the prognosis of NDMM patients and may indicate an increased risk of early mortality for patients.