摘要
目的 探讨高危细胞遗传学异常和血红蛋白水平对多发性骨髓瘤疗效的预测价值.方法 采用回顾性分析方法,收集2015年1月至2022年12月在宁德师范学院附属宁德市医院血液科就诊的新诊断的多发性骨髓瘤患者84例,筛选其中规范行3～4周期化疗的60例患者最终纳入分组研究.根据疗效评估结果分为治疗无效组(n=22)和治疗有效组(n=38).比较两组一般资料,包括性别、年龄、骨髓瘤分型、Durie-Salmon(D-S)分期、国际分期体系(ISS)分期、体能状态评分[美国东部肿瘤协作组(ECOG)评分]、合并疾病等,以及实验室指标,包括血红蛋白、球蛋白、白蛋白、肌酐、乳酸脱氢酶(LDH)、血清尿酸、D-二聚体、β2-微球蛋白、C-反应蛋白(CRP)、红细胞沉降率(ESR)、血清铁蛋白、细胞遗传学结果等临床资料的差异.采用多因素Logistic回归分析影响多发性骨髓瘤疗效的因素.采用受试者操作特征(ROC)曲线评定高危细胞遗传学异常和血红蛋白降低对新诊断多发性骨髓瘤常规化疗无效的预测价值.结果 治疗无效组与治疗有效组的性别、年龄、骨髓瘤分型、D-S分期、ISS分期、体能状态评分、合并疾病等一般资料比较,差异均无统计学意义(P＞0.05).两组的球蛋白、白蛋白、肌酐、LDH、CRP、ESR、血清铁蛋白等比较,差异均无统计学意义(P＞0.1);治疗无效组血红蛋白为(68.68±24.41)g/L,低于治疗有效组[(101.05±29.44)g/L],治疗无效组血清尿酸、D-二聚体、β2-微球蛋白分别为(491.52±188.33)μmol/L、(3.74±4.72)ng/L、(10.12±7.69)mg/L,高于治疗有效组[(413.75±122.52)μmol/L、(1.33±1.74)ng/L、(6.64±5.00)mg/L],差异均有统计学意义(P＜0.1).多因素Logistic回归分析,得出血红蛋白降低、高危遗传学异常是治疗无效的影响因素(OR=0.959,95％CI:0.925～0.994;OR=2.031,95％CI:0.449～3.612;P＜0.05).ROC曲线分析得出高危细胞遗传学异常和血红蛋白对新诊断多发性骨髓瘤初始常规化疗无效有一定预测能力,其曲线下面积(AUC)值分别为0.748、0.774,二者联合的AUC值达到0.836.结论 血红蛋白降低和高危细胞遗传学异常是新诊断多发性骨髓瘤常规化疗治疗无效的危险因素,均可作为疗效预测的指标.
Abstract
Objective This study aims to investigate the predictive value of high-risk cytogenetic abnormalities and hemoglobin levels in patients with multiple myeloma.Methods A retrospective analysis was conducted on 84 newly diagnosed multiple myeloma patients at the Depart-ment of Hematology,Ningde Hospital Affiliated to Ningde Normal University from January 2015 to December 2022.Among them,a total of 60 pa-tients who received 3-4 cycles of chemotherapy were screened for inclusion.According to the results of efficacy evaluation,they were divided into ineffective treatment group(n=22)and effective treatment group(n=38).The differences of general data,including gender,age,myeloma type,Durie-Salmon(D-S)stage,International Staging System(ISS)stage,physical fitness score[Eastern Cooperative Oncology Group(ECOG)],the clinical data,including hemoglobin,globulin,albumin,creatinine,lactate dehydrogenase(LDH),serum uric acid,D-dimer,β2-microglobulin,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),serum ferritin,cytogenetic results,ect of two groups were compared.The factors influencing the efficacy of multiple myeloma treatment was performed by Multivariate Logistic regression analysis.The value of high-risk cytogenetic abnormalities and decreased hemoglobin levels in predicting the probability of failure of conventional chemotherapy for newly diagnosed multiple myeloma were utilized by receiver operating characteristic(ROC)curves.Results There was no significant differ-ence in gender,age,myeloma type,D-S stage,ISS stage,physical status score,combined disease and other general data between the ineffective treatment group and the effective treatment group(P＞0.05).There was no significant difference in globulin,albumin,creatinine,LDH,CRP,ESR and serum ferritin between the two groups(P＞0.1).The hemoglobin in the ineffective treatment group was(68.68±24.41)g/L,which was lower than that in the effective treatment group[(101.05±29.44)g/L],the serum uric acid,D-dimer and β2-microglobulin in the inef-fective treatment group were(491.52±188.33)µmol/L,(3.74±4.72)ng/L and(10.12±7.69)mg/L,respectively,which was higher than that in the effective group[(413.75±122.52)µmol/L,(1.33±1.74)ng/L,(6.64±5.00)mg/L],and the differences were statistically significant(P＜0.1).Logistic regression analysis revealed that decreased hemoglobin levels and high-risk genetic abnormalities were influential factors for treatment failure(OR=0.959,95％CI:0.925-0.994;OR=2.031,95％CI:0.449-3.612;P＜0.05).ROC curve analysis demonstrated that high-risk cytogenetic abnormalities and hemoglobin levels had predictive ability for initial conventional chemotherapy in newly diagnosed multiple myeloma patients with area under the curve(AUC)values of 0.748 and 0.774 respectively,while the combined AUC value reached 0.836.Conclusion Decreased hemoglobin levels and high-risk cytogenetic abnormalities are risk factors for the failure of conventional chemotherapy in newly diagnosed multiple myeloma patients and can serve as prognostic indicators.
维普
万方数据