VRD治疗的多发性骨髓瘤患者中性粒细胞/白蛋白比值变化及其与短期预后的关系

Changes in Neutrophil Percentage-to-Albumin Ratio and Its Relationship with Short-Term Prognosis in Patients with Multiple Myeloma Treated with VRD

目的:分析多发性骨髓瘤(MM)患者硼替佐米+来那度胺+地塞米松(VRD)治疗期间中性粒细胞/白蛋白比值(NPAR)的动态变化,探讨NPAR值与MM患者短期预后的关系。方法:纳入2019年1月-2021年4月期间在唐山市工人医院采用VRD方案化疗的80例MM患者的资料进行回顾性研究,分别在VRD化疗前(T0)、第3个化疗周期(T1)、第6个化疗周期(T2)、第8个化疗周期(T3)时检测NPAR水平。所有患者接受1年随访,随访“终点事件”为患者VRD治疗结束后1年内发生复发、进展或死亡情况,根据随访结果将患者分为预后良好组与预后不良组,统计T0、T1、T2、T3等时点NPAR的变化情况;采用限制性立方样条法分析NPAR与VRD化疗MM患者短期预后不良的关系。结果:80例MM患者中,短期预后不良25例(31.25%),包括进展或复发19例(23.75%),全因死亡6例(7.50%)。预后不良组T0、T1、T2、T3时的中性粒细胞、NPAR水平均高于同期的预后良好组,T0、T1、T2时白蛋白水平低于同期的预后良好组(P<0.05);预后不良组与预后良好组T3时白蛋白水平比较无显著差异(P>0.05)。预后不良组与预后良好组两组内T0、T1、T2、T3时的中性粒细胞、NPAR水平依次降低,白蛋白水平依次升高,各阶段差异均有统计学意义(P<0.05)。通过限制性立方样条模型分析发现,MM患者短期预后不良风险与治疗前NPAR水平间呈近似J型曲线,当治疗前NPAR>0.52时,MM患者短期预后不良风险随NPAR值升高而升高(P<0.05)。结论:MM患者经VRD治疗后,其NPAR值逐渐降低,且MM患者VRD治疗前NPAR值与治疗后预后不良发生风险存在相关性,当NPAR>0.52时,NPAR值越高,患者发生短期预后不良风险越高。

Objective:To analyze the dynamic changes of neutrophil percentage-to-albumin ratio(NPAR)during treatment with bortezomib-lenalidomide-dexamethasone(VRD)in patients with multiple myeloma(MM),and explore the relationship between NPAR value and short-term prognosis of MM patients.Method:The data of 80 MM patients who underwent VRD chemotherapy at Tangshan Workers Hospital from January 2019 to April 2021 were retrospectively analyzed.NPAR levels were measured before VRD chemotherapy(T0),and on the first day of the third(T1),sixth(T2),and eighth(T3)chemotherapy cycles.All patients were followed up for 1 year,with the recurrence,progression,or death occurring within 1 year after the completion of VRD treatment as the endpoint event.The patients were divided into a good prognosis group and a poor prognosis group based on the follow-up results.The changes in NPAR at T0,T1,T2,and T3 in the two groups were statistically analyzed.The restricted cubic spline method was used to analyzed the relationship between NPAR and adverse short-term prognosis in MM patients undergoing VRD chemotherapy.Results:Among the 80 MM patients,25 cases(31.25%)had poor short-term prognosis,including 19 cases(23.75%)of progression or recurrence,and 6 cases(7.50%)of all-cause mortality.The levels of neutrophils and NPAR in the poor prognosis group at T0,T1,T2 and T3 were higher than those in the good prognosis group at the same period,while the albumin levels in the poor prognosis group at T0,T1,and T2 were lower than those in the good prognosis group at the same period(P<0.05);There was no significant difference in albumin levels between the poor prognosis group and the good prognosis group at T3(P>0.05).Within the poor prognosis group and the good prognosis group,the levels of neutrophils and NPAR decreased sequentially at T0,T1,T2,and T3,while the levels of albumin increased sequentially,and the differences between each stage were statistically significant(P<0.05).The restricted cubic spline model showed an approximate J-shaped curve between the risk of poor short-term prognosis and the pre-treatment NPAR level in MM patients(P<0.05).If the pre-treatment NPAR>0.52,the risk of poor short-term prognosis in MM patients increased with the increase of NPAR value.Conclusion:After VRD treatment,the NPAR value of MM patients gradually decreases,and there is a correlation between the NPAR value before VRD treatment and the risk of poor prognosis after treatment.If NPAR>0.52 before treatment,the higher the NPAR value,the higher the risk of poor short-term prognosis in MM patients.