淋巴细胞数与单核细胞数比值对初诊65岁以上多发性骨髓瘤病人预后的评估价值

doi:10.3969/j.issn.1003-9198.2021.06.011

摘要/Abstract

摘要： 目的探讨淋巴细胞数与单核细胞数比值(LMR)评估初诊65岁以上多发性骨髓瘤病人预后的价值。方法选取2014年1月至2019年1月江苏大学附属宜兴医院收治的81例初诊老年多发性骨髓瘤病人,收集病人治疗前淋巴细胞数、单核细胞数,计算LMR。采用ROC曲线判断LMR预测预后的截断值,并将病人分为低LMR组及高LMR组。对病人进行随访,观察病人生存情况,分析LMR与总生存期(OS)和无病生存期(DFS)的关系。结果共75例病人得到随访,6例失访,随访成功率为92.6%。随访时间12~72个月,中位随访时间为24个月。ROC曲线分析结果显示,LMR预测老年多发性骨髓瘤病人死亡的AUC为0.78(P=0.003),特异度为65.2%,灵敏度为81.0%。低LMR组完全缓解率(26.67%)低于高LMR组(60.00%),差异具有统计学意义(P<0.05)。低LMR组DS分期Ⅲ期比例高于高LMR组(P<0.05),OS、DFS较高LMR组缩短,差异具有统计学意义(P<0.05)。多因素Cox回归分析结果显示,LMR、年龄、LDH、DS分期是老年多发性骨髓瘤病人OS的独立影响因素(P<0.05),LMR、LDH、DS分期是老年多发性骨髓瘤病人DFS的独立影响因素(P<0.05)。结论 LMR在预测老年初诊多发性骨髓瘤病人预后中具有一定价值, 即LMR降低,病人死亡风险高。

关键词: 淋巴细胞数与单核细胞数比值, 老年人, 多发性骨髓瘤, 死亡

Abstract: Objective To explore the value of lymphocyte-to-monocyte ratio (LMR) in evaluating the prognosis of multiple myeloma in the elderly aged over 65 years old at the first diagnosis. Methods From January 2014 to January 2019, 81 newly diagnosed elderly patients with multiple myeloma who were admitted to Yixing Hospital of Jiangsu University were enrolled. The number of lymphocytes and monocytes before treatment were collected, and LMR was calculated. The receiver operating characteristic (ROC) curve was used to determine the cutoff value of LMR in predicting the prognosis. All the patients were divided into high LMR group and low LMR group according to the cutoff value. The patients were followed up, and the relationship between LMR and overall survival (OS) and disease-free survival (DFS) was analyzed. Results A total of 75 patients were followed up, with a follow-up success rate of 92.6%. The follow-up time was 12-72 months, with a median follow-up time of 24 months. The results of ROC curve analysis showed that the area under the curve for predicting the death by LMR was 0.78 (P=0.003), with a specificity of 65.2% and a sensitivity of 81.0%, and the LMR cutoff was 0.15. The complete response rate in the low LMR group was lower than that in the high LMR group (26.67% vs 60.00%, P<0.05). The proportion of Durie-Salmon (DS) stage Ⅲ in the low LMR group was higher than that in the high LMR group(P<0.05). The Kaplan-Meier method and Log-rank test showed that the OS, DFS in the low LMR group were shorter than those in the LMR group (P<0.05). Cox multivariate analysis showed that LMR, age, LDH and DS staging were independent factors affecting OS (P<0.05), and LMR, LDH and DS staging were independent influencing factors of DFS in the elderly patients with multiple myeloma (P<0.05). Conclusions LMR has significant value in predicting the prognosis of the elderly patients with newly diagnosed multiple myeloma.

Key words: lymphocyte-to-monocyte ratio, aged, multiple myeloma, death

中图分类号:

R 733.33

金玲, 周志刚. 淋巴细胞数与单核细胞数比值对初诊65岁以上多发性骨髓瘤病人预后的评估价值[J]. 实用老年医学, 2021, 35(6): 580-583.

JIN Ling, ZHOU Zhi-gang. Study on lymphocyte-to-monocyte ratio in evaluating prognosis of multiple myeloma in elderly patients[J]. Practical Geriatrics, 2021, 35(6): 580-583.

参考文献

[1] 吴晓晓, 陈文明.多发性骨髓瘤治疗进展[J]. 白血病·淋巴瘤,2019,28(2):65-68.
[2] 陈旭端, 骆晓峰, 祖燕萍, 等.初诊多发性骨髓瘤病人的血清游离轻链对肾功能及预后的影响[J]. 中国实验血液学杂志,2019,27(6):1862-1868.
[3] 金媛媛, 陈丽娟, 史青林, 等.老年多发性骨髓瘤细胞遗传学特征分析[J]. 实用老年医学, 2019,33(12):1190-1192.
[4] 王邦杰,王葆春.术前PLR、LMR与胃癌病人预后的相关性研究[J]. 中国肿瘤外科杂志,2019,11(2):102-106.
[5] 孟以秀,熊林.炎症反应相关指标与CA125对卵巢良、恶性肿瘤鉴别诊断意义[J]. 中国计划生育学杂志,2019,27(9):1174-1176,1179.
[6] SHI L, QIN X, WANG H, et al. Elevated neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio and decreased platelet-to-lymphocyte ratio are associated with poor prognosis in multiple myeloma[J]. Oncotarget,2017,8(12):18792-18801.
[7] 汪英颖,刘尚勤.多发性骨髓瘤诊治指南解读(2018年)[J]. 临床内科杂志,2018,35(7):503-504.
[8] 颜玲玲,费小明,汤郁, 等.多西环素对人多发性骨髓瘤细胞增殖的影响[J]. 江苏大学学报:医学版,2017,27(3):239-242,247.
[9] 郭彩玲.硼替佐米联合地塞米松、沙利度胺治疗多发性骨髓瘤的临床研究[J]. 中国医刊,2019,54(12):1376-1379.
[10]马成成,柴晔,王鑫, 等.化疗后免疫状态的改变对初诊多发性骨髓瘤病人的预后价值[J]. 中国实验血液学杂志,2019,27(6):1869-1875.
[11]董亚青,马艳萍.外周血单核细胞/淋巴细胞比值在接受硼替佐米治疗的初诊多发性骨髓瘤病人预后中的价值[J]. 临床血液学杂志,2019,32(5):375-380.
[12]贾雁春,杜鹃.多发性骨髓瘤的预后评估体系[J]. 临床检验杂志,2019,37(11):820-824.

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