摘要
目的 研究CD28在初诊多发性骨髓瘤(MM)患者中的表达及其与肿瘤负荷、临床预后的相关性.方法 以回顾性分析为法,观察对象为2021年1月至2023年1月淮南市第一人民医院的89例初诊MM患者.所有患者均经流式细胞术对其骨髓标本予以免疫表型分析,参考CD28表达水平分为CD28+(研究组,n=30)与CD28-(对照组,n=59).对比两组患者的实验室特征、CD28表达水平、遗传学异常发生率和近期疗效,分析CD28表达对无进展生存期(PFS)的影响.结果 两组患者的年龄、性别构成比、白蛋白、乳酸脱氢酶、肌酐、血红蛋白、钙水平比较,差异均无统计学意义(P＞0.05);研究组β2微球蛋白表达水平、克隆浆细胞比率、骨髓浆细胞(BMPC)比率、国际分期系统(ISS)-Ⅲ期患者比率分别为(6.61±1.14)mg/L、(21.68±5.82)％、(41.83±8.62)％、73.33％,均明显高于对照组[(5.68 ±1.07)mg/L、(10.97±4.12)％、(27.01±7.14)％、47.46％],差异均有统计学意义(P＜0.05).研究组患者 1q21 扩增发生率、≥2个遗传学异常的高危病例发生率分别为40.00％、26.67％,均明显高于对照组(18.64％、8.47％),差异均有统计学意义(P＜0.05);两组13q14-、IgH重排、17p-发生率比较,差异均无统计学意义(P＞0.05).化疗4个周期之后,研究组患者的治疗总有效率为60.00％,明显低于对照组(88.14％),差异有统计学意义(P＜0.05).中位随访10个月,研究组患者中位PFS为(10.72±1.23)个月,明显低于对照组[(14.08±1.34)个月],差异有统计学意义(P＜0.05).单因素分析显示,CD28+表达及≥2个遗传学异常、ISS Ⅲ期、血红蛋白＜60 g/L、年龄≥60岁并非影响MM患者PFS的危险因素;多因素分析显示,影响MM患者PFS的独立危险因素为CD28+表达、诱导效果＜PR.结论 CD28+与初诊MM患者临床特征、肿瘤负荷及预后有着密切联系,CD28+可辅助评估初诊MM患者的预后.
Abstract
Objective To study the expression of CD28 in newly diagnosed patients with multiple myeloma(MM)and its correlation with tumor load and clinical prognosis.Methods By retrospective analysis,89 newly diagnosed MM patients in Huainan First People's Hospital from January 2021 to January 2023 were observed.All patients were analyzed by flow cytometry,and were divided into CD28+(study group,n=30)and CD28-(control group,n=59)according to the expression level of CD28.The laboratory characteristics,CD28 expression level,genetic ab-normality rate and short-term curative effect of the two groups were compared,and the influence of CD28 expression on progression-free-sur-vival(PFS)was analyzed.Results There were no statistically significant differences in age,gender composition ratio,albumin,lactate dehydro-genase,creatinine,hemoglobin,and calcium levels between the two groups of patients(P＞0.05);the expression levels of β2-microglobulin,the ratio of cloned plasma cells,the ratio of bone marrow plasma cells(BMPC),and the ratio of International Staging System(ISS)-phase Ⅲpatients in the study group were(6.61±1.14)mg/L,(21.68±5.82)％,(41.83±8.62)％,and 73.33％,respectively,which were signifi-cantly higher than those in the control group[(5.68±1.07)mg/L,(10.97±4.12)％,(27.01±7.14)％,and 47.46％],and the differ-ences were statistically significant(P＜0.05).The incidence of 1 q21 amplification and the incidence of high-risk cases with ≥2 genetic abnor-malities in the study group were 40.00％and 26.67％,respectively,which were significantly higher than those in the control group(18.64％and 8.47％),and the differences were statistically significant(P＜0.05);there were no statistically significant differences in the incidence of 13q14-IgH rearrangement,and 17p-between the two groups(P＞0.05).After 4 cycles of chemotherapy,the total effective rate of patients in the study group was 60.00％,which was significantly lower than that in the control group(88.14％),and the difference was statistically sig-nificant(P＜0.05).After a median follow-up of 10 months,the progression-free survival(PFS)in the study group was(10.72±1.23)months,which was significantly lower than that in the control group[(14.08±1.34)months],and the difference was statistically significant(P＜0.05).Univariate analysis showed that CD28+expression and ≥2 genetic abnormalities,ISS Ⅲ,hemoglobin＜60 g/L and age ≥60 years were not risk factors for PFS in MM patients.Multivariate analysis showed that the independent risk factors of PFS in MM patients were CD28+expression and induction effect＜PR.Conclusion CD28+is closely related to the clinical features,tumor load and prognosis of newly diagnosed MM patients,and CD28+can assist in evaluating the prognosis of newly diagnosed MM patients.
基金项目
安徽省卫生健康委员会科研课题(Z20200272)
维普
万方数据