目的 探讨肾功能指标胱抑素 C(cystatin C,Cys C)、补体 C1q(complement C1q)、β2-微球蛋白(β2-microglobu-lin,β2-MG)、尿素(Urea)、尿酸(uric acid,UA)对初诊多发性骨髓瘤(multiplemyeloma,MM)患者合并肾损伤(renal impairment,RI)的诊断价值.方法 回顾性分析2021 年8 月～2022 年12 月首都医科大学附属北京积水潭医院血液科收治的93 例初诊MM患者的病例资料,按照血肌酐水平将 MM 患者分为 RI 组[血肌酐>176.80mmol/L(2mg/dl),n = 19]及非 RI 组[血肌酐≤176.80mmol/L(2mg/dl),n =74],对 RI组和非 RI组的临床资料及实验室指标进行分析.采用单因素和多因素 Logistic回归分析评价 MM 患者发生 RI的危险因素,应用受试者工作特征(receiver operating characteristic,ROC)曲线评估危险因素对 MM 患者发生 RI的预测价值.结果 93 例初诊 MM 患者发生 RI者占 25.68%,RI组轻链型占比最高(36.84%,7/19),IgG-λ型和 IgA-κ型比例最低(10.53%,2/19);非RI组IgA-κ型比例最高(29.73%,22/74),IgG-λ型比例最低(12.16%,9/74).DS分期中,RI组 19 例全部为Ⅲ期,非 RI 组 72 例全部为Ⅲ期.ISS 分期中,RI 组Ⅲ期最多(68.42%,13/19),非 RI 组中Ⅰ期最多(41.89%,31/74).RISS分期中,RI组Ⅱ期和Ⅲ期最多(36.84%,7/19),非RI组Ⅱ期最多(58.11%,43/74).DS分期和ISS分期组间差异有统计学意义(P<0.05).RI组中 Cys C、β2-MG、Urea、UA水平均高于非 RI组,差异均有统计学意义(P<0.05).单因素分析结果显示,Cys C、Urea、β2-MG水平异常升高是MM 患者发生RI的危险因素(P<0.05),C1q对MM 患者发生RI没有影响(P>0.05);多因素 Logistic回归分析结果显示,Cys C、Urea、β2-MG水平异常升高均是 MM 患者发生 RI的独立影响因素(P<0.05).Cys C、Urea、β2-MG预测 MM 患者发生 RI的敏感度分别为 88.9%、50.0%、94.4%,特异性分别为 90.4%、100.0%、84.9%;Cys C、Urea、β2-MG联合检测预测MM 患者发生RI的敏感度为100.0%,特异性为87.7%.结论 Cys C、Urea、β2-MG均能较好地预测初诊 MM 患者发生 RI的可能性,3 项指标联合检测对 MM 患者发生 RI具有更高的预测价值.
Diagnostic Value of Cys C,C1q,β2-MG,Urea and UA in Newly Diagnosed Multiple Myeloma Patients with Renal Impairment
Objective To investigate the diagnostic value of renal function indexes cystatin C(Cys C),Complement C1q(comple-ment C1q),β2-microglobulin(β2-MG),Urea,uric acid(UA)in newly diagnosed multiplemyeloma(MM)with renal impairment(RI).Methods The case data of 93 newly diagnosed MM patients admitted to the Department of Hematology,Beijing Jishuitan Hospi-tal,Capital Medical University from August 2021 to December 2022 were retrospectively analyzed.According to serum creatinine level,MM patients were divided into RI group[serum creatinine>176.80mmol/L(2mg/dl),n =19]andnon-RIgroup[serumcreatinine≤176.80mmol/L(2mg/dl),n =74].The clinical data and laboratory indexes of RI group and non-RI group were analyzed.Univariate and multivariate Logistic regression analysis was used to evaluate the risk factors for RI in MM patients,and the receiver operating charac-teristic(ROC)curve was used to evaluate the predictive value of risk factors for RI in MM patients.Results The proportion of RI in 93 newly diagnosed MM patients was25.68%.The proportion of light chain type in RI group was the highest(36.84%,7/19),and the proportion of IgG-λ type and IgA-κ type was the lowest(10.53%,2/19).The proportion of IgA-κ type was the highest(29.73%,22/74)and IgG-λ type was the lowest(12.16%,9/74)in non-RI group.All 19 patients in the RI group were in DS stage Ⅲ,and 72 patients in the non-RI group were in DS stage Ⅲ.In ISS staging,the RI group had the moststage Ⅲ(68.42%,13/19),and the non-RI group had the most stage Ⅰ(41.89%,31/74).In RISS staging,stage Ⅱ and Ⅲ were the most common in the RI group(36.84%,7/19),and stage Ⅱ was the most common in the non-RI group(58.11%,43/74).There were significant differences in DS stage and ISS stage between the two groups(P<0.05).The levels of Cys C,β2-MG,Urea and UA in the RI group were higher than those in the non-RI group,and the differences were statistically significant(P<0.05).The results of univariate analysis showed that abnormally high levels of Cys C,Urea and β2-MG were the risk factors for RI in MM patients(P<0.05),C1q had no effect on RI oc-currence in MM patients(P>0.05).Multivariate Logistic regression analysis showed that abnormally high levels of Cys C,Urea and β2-MG were independent influencing factors for RI in MM patients(P<0.05).The sensitivity of Cys C,Urea and β2-MG to predicti RI in MM patients were 88.9%,50.0%and 94.4%,respectively,and the specificity was 90.4%,100.0%and 84.9%,respectively.The sensitivity and specificity of combined detection of Cys C,Urea and β2-MG were 100.0%and 87.7%,respectively.Conclusion Cys C,Urea and β2-MG can better predict the possibility of RI in newly diagnosed MM patients,and the combined detection of the these three indicators has a higher predictive value for RI in MM patients.
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