血清碱性磷酸酶和白细胞介素6以及乳酸脱氢酶水平联合检测对多发性骨髓瘤诊断的价值

The diagnostic value of combined detection of serum ALP,IL-6,and LDH levels in patients with multiple myeloma

目的探讨血清碱性磷酸酶(ALP)、白细胞介素6(IL-6)、乳酸脱氢酶(LDH)联合检测对多发性骨髓瘤(MM)患者的诊断价值。方法回顾性分析2019年5月至2024年5月南阳市中医院收治的154例单克隆免疫球蛋白阳性患者资料,经病理检查确诊为MM的患者纳入病例组(85例),否则纳入对照组(69例)。比较病例组和对照组以及不同病理分期病例组患者血清ALP、IL-6、LDH水平、骨髓浆细胞比例的差异,分析血清ALP、IL-6、LDH与骨髓浆细胞比例以及MM病理分期的相关性。以受试者工作特征(ROC)曲线分析各血清指标单独或联合检测诊断MM的价值,以相对危险度分析不同血清ALP、IL-6、LDH水平患者发生MM的风险。结果病例组患者血清ALP、IL-6、LDH水平以及骨髓浆细胞比例均明显高于对照组(均P<0.05)。Ⅰ期(32例)患者血清ALP、IL-6、LDH水平以及骨髓浆细胞比例均明显小于Ⅱ期患者(均P<0.05),Ⅱ期(29例)患者血清ALP、IL-6、LDH水平以及骨髓浆细胞比例均明显小于Ⅲ期(24例)患者(均P<0.05)。MM患者血清ALP、IL-6、LDH水平与骨髓浆细胞比例呈正相关(γ值分别为0.684、0.692和0.675,均P<0.001);MM患者血清ALP、IL-6、LDH水平与病理分期也呈正相关(γ值分别为0.648、0.634和0.662,均P<0.001)。血清ALP、IL-6、LDH水平联合检测诊断MM的曲线下面积(AUC)为0.917,约登指数为0.796,敏感度和特异度分别为94.1%和85.5%。血清ALP、IL-6、LDH高水平患者诊断为MM的相对危险度分别是低水平患者的4.211、4.266和4.658倍。结论MM患者血清ALP、IL-6、LDH水平均有异常升高,并随着病理分期的推进各指标水平逐渐升高;血清ALP、IL-6、LDH联合检测可为临床诊断MM提供一定参考价值。

Objective To explore the diagnostic value of combined detection of serum alkaline phosphatase(ALP),interleukin-6(IL-6),and lactate dehydrogenase(LDH)in patients with multiple myeloma(MM).Methods A retrospective analysis was conducted on 154 patients with monoclonal immunoglobulin positivity admitted to Nanyang Traditional Chinese Medicine Hospital from May 2019 to May 2024.Patients diagnosed with MM through pathological examination were included in the case group(85 patients),and those without MM were included in the control group(69 patients).The differences in serum ALP,IL-6,LDH levels,and bone marrow plasma cell percentage between the case and control groups,as well as among patients with different pathological stages of MM,were compared.The correlations between serum ALP,IL-6,LDH levels,bone marrow plasma cell percentage,and pathological stage of MM were analyzed.The diagnostic value of serum markers alone or in combination for MM was evaluated by receiver operating characteristic(ROC)curve analysis,and the relative risk of MM occurrence in patients with different serum levels of ALP,IL-6,and LDH was assessed.Results The serum levels of ALP,IL-6,LDH,and bone marrow plasma cell percentage in the case group were significantly higher than those in the control group(all P<0.05).In stageⅠpatients(32 cases),serum ALP,IL-6,LDH levels,and bone marrow plasma cell percentage were significantly lower than in stageⅡpatients(29 cases,all P<0.05),and the levels in stageⅡwere significantly lower than in stageⅢpatients(24 cases,all P<0.05).The serum levels of ALP,IL-6,LDH,and bone marrow plasma cell percentage were positively correlated in MM patients(γvalues:0.684,0.692,and 0.675,respectively,all P<0.001).These serum markers were also positively correlated with pathological stage(γvalues:0.648,0.634,and 0.662,respectively,all P<0.001).The area under the curve(AUC)for the combined detection of ALP,IL-6,and LDH in diagnosing MM was 0.917,with a Youden index of 0.796,sensitivity of 94.1%,and specificity of 85.5%.The relative risk of diagnosing MM in patients with high serum ALP,IL-6,and LDH levels was 4.211,4.266,and 4.658 times that of patients with low levels,respectively.Conclusions Serum ALP,IL-6,and LDH levels are abnormally elevated in MM patients,and these markers increase progressively with advancing pathological stages.Combined detection of serum ALP,IL-6,and LDH provides valuable reference information for the clinical diagnosis of MM.