摘要
目的 探讨血清乳酸脱氢酶(LDH)、β_(2)-微球蛋白(β_(2)-MG)水平与多发性骨髓瘤(MM)患者预后的关系。方法 收集105例MM患者的临床资料,采用美国东部肿瘤协作组制定的ZPS标准评估患者预后,将ZPS评分﹥3分的37例患者纳入预后不良组,ZPS评分≤3分的68例患者纳入预后良好组。比较预后不良组和预后良好组患者的临床特征;采用Cox比例风险回归模型分析MM患者预后不良的独立危险因素;采用Spearman相关分析法分析ZPS评分、Durie-Salmon(DS)分期与LDH、β_(2)-MG水平的相关性;采用受试者工作特征(ROC)曲线分析LDH、β_(2)-MG对MM患者预后不良的评估价值,计算曲线下面积(AUC)。结果 预后不良组中并发重度贫血、骨髓浆细胞比例﹥30%、DS分期为Ⅲ期的患者比例均明显高于预后良好组,血清LDH、β_(2)-MG水平均明显高于预后良好组,差异均有统计学意义(P﹤0.01)。多因素Cox比例风险回归分析结果显示,并发重度贫血、骨髓浆细胞比例﹥30%、DS分期为Ⅲ期、血清LDH和β_(2)-MG水平异常升高均是MM患者预后不良的独立危险因素(P﹤0.01)。Spearman相关分析结果显示,ZPS评分与MM患者的血清LDH、β_(2)-MG水平均具有较高相关性(r=0.869、0.962,P﹤0.01),DS分期与MM患者的血清LDH、β_(2)-MG水平均具有中等相关性(r=0.673、0.616,P﹤0.01)。LDH对MM患者预后不良具有中等评估价值(AUC=0.876,P﹤0.05),β_(2)-MG对MM患者预后不良具有较高评估价值(AUC=0.978,P﹤0.05)。结论 并发重度贫血、骨髓浆细胞比例﹥30%、DS分期为Ⅲ期、血清LDH和β_(2)-MG水平异常升高均是MM患者预后不良的独立危险因素。LDH、β_(2)-MG水平与MM患者的预后和临床分期均具有相关性,可为病情和预后评估提供参考。
Objective To explore the relationship of serum lactate dehydmgenase(LDH)and β_(2)-microglobulin(β_(2)-MG)levels with prognosis of multiple myeloma(MM)patients.Method The clinical data of 105 patients with MM were collected,the prognosis of the patients was evaluated by ZPS criteria formulated by Eastern Cooperative Oncology Group.According to the evaluation results,all patients were divided into poor prognosis group(n=37,ZPS scores>3 points)and good prognosis group(n=68,ZPS scores≤3 points).The clinical characteristics of the two groups were com-pared.Cox proportional risk regression model was used to analyze the independent risk factors for poor prognosis of MM patients.The correlation of ZPS score and Durie-Salmon(DS)stage with LDH and β_(2)-MG levels were analyzed by using Spearman correlation analysis,and the evaluation value of LDH and β_(2)-MG for poor prognosis was calculated by receiver operation characteristic(ROC)curve analysis,and area under the curve(AUC)was calculated.Result The proportion of patients with severe anemia,plasma cells in bone marrow>30%,DS stage III and levels of serum LDH and β_(2)-MG in poor prognosis group were higher than those in good prognosis group(P<0.01).Multivariate Cox proportional risk regression analysis showed that severe anemia,plasma cells in bone marrow>30%,DS stage III,abnormally increased serum LDH and β_(2)-MG were independent risk factors for poor prognosis of MM patients(P<0.01).Spearman correlation analysis showed there were high correlation of ZPS score with LDH and β_(2)-MG levels(r=0.869,0.962,P<0.01),and moderate cor-relation of DS stage with LDH and β_(2)-MG levels(r=0.673,0.616,P<0.01).LDH had moderate value in evaluating the poor prognosis of MM patients(AUC=0.876,P<0.05)and β_(2)-MG had higher value in evaluating the poor prognosis of MM patients(AUC=0.978,P<0.05).Conclusion Severe anemia,plasma cells in bone marrow>30%,DS stage III,abnor-mally increased serum LDH and β_(2)-MG are independent risk factors for poor prognosis of MM patients.The levels of LDH and β_(2)-MG are correlated to prognosis and clinical stage of MM patients,which can be used to provide reference for condition and prognosis evaluation.
作者
任静静
杨瑜
王珊珊
REN Jingjing;YANG Yu;WANG Shanshan(Department of Clinical Laboratory,Xinxiang Central Hospital,Xinxiang 453000,He’nan,China)
出处
《癌症进展》
2023年第12期1337-1340,共4页
Oncology Progress
