多发性骨髓瘤预后的影响因素研究  

Influencing Factors for the Prognosis of Multiple Myeloma

作　　者：陆敏秋[1] 褚彬[1] 白砚霞[1] 左杏果[1] 吴梦青[1] 石磊[1] 付丽娜[1] 高珊[1] 房立娟[1] 项秋晴 

机构地区：[1]北京积水潭医院血液科北京大学第四临床医学院,北京市100035

出　　处：《中国全科医学》2016年第6期658-665,共8页Chinese General Practice

基　　金：北京市医院管理局临床医学发展专项经费资助(XMLX201502)

摘　　要：目的探讨临床特征、实验室指标、治疗方案对多发性骨髓瘤（MM）预后的意义。方法选取2000年1月—2012年3月北京积水潭医院血液科确诊的初治MM并行化疗、有完整随访资料的患者202例为研究对象,均采用化疗,42例合并放疗。记录患者的性别、年龄、分型、有无重度贫血、血β2微球蛋白水平、C反应蛋白水平、有无低蛋白血症、血钙水平、乳酸脱氢酶水平、骨髓浆细胞比例、骨病分级（MBD分级）、美国东部肿瘤协作组体力状况评分（ECOG评分）、有无复杂核型（G显带核型分析）、有无淀粉样变、有无肾损伤、有无截瘫及是否达到完全缓解（CR）、有无沙利度胺维持治疗（治疗≥6个月）。随访至2015年3月,随访时间1.0-180.0个月。采用多因素Cox比例风险回归分析各因素及采用生存曲线分析DS分期、ISS分期与MM患者总生存期（OS）、无进展生存期（PFS）的相关性;19例患者在确诊后6个月内死亡,采用多因素Logistic回归分析早期死亡的影响因素;根据OS和PFS的共同影响因素及ISS分期对患者进行危险因素分层,分为高危组、中危组、低危组,分析不同危险因素分层患者的预后。结果 202例MM患者中53例（26.2%）达到CR,96例（47.5%）达到非常好的部分缓解（VGPR）,29例（14.4%）达到部分缓解（PR）,总有效率为88.1%。截至随访时间死亡120例。1、3、5、10年生存率分别为80.7%、70.6%、36.1%、7.6%。OS为1.0-180.0个月,中位OS为51.0个月;PFS为1.0-91.0个月,中位PFS为38.0个月。多因素Cox比例风险回归分析结果显示,年龄、重度贫血、低蛋白血症、复杂核型、淀粉样变、截瘫、沙利度胺维持治疗与OS有回归关系（P0.05）。不同DS分期患者PFS比较,差异有统计学意义（χ-2=12.222,P〈0.05）。不同ISS分期患者OS、PFS比较,差异有统计学意义（χ-2值分别为15.037及32.222,P〈0.05）。单因素分析结果显示,有无重�Objective To investigate the significance of clinical features,laboratory indexes and treatment regimen on the prognosis of multiple myeloma（ MM）. Methods Enrolled 202 patients who were newly diagnosed with MM and had complete follow- up data in the Department of Hematology of Beijing Jishuitan Hospital From January 2000 to March 2012. All the patients underwent chemotherapy. Among them,42 patients underwent chemoradiotherapy. The observed indexes included gender,age,typing, having severe anemia or not, blood level of β2- microglobulin, C- reactive protein level, having hypoalbuminemia or not,blood calcium level,lactic dehydrogenase level,proportion of bone marrow plasma cells,bone disease grading（ MBD grading）, ECOG score, complex karyotype（ G banding karyotype analysis）, amyloidosis, renal injury,paraplegia,whether treatment achieved complete remission（ CR） and whether thalidomide maintenance therapy was conducted or not（ treatment duration≥6 months）. Follow- up ended in March 2015,lasting for 1. 0- 180. 0 months. Multivariate Cox proportionnal hazards regression analysis and survival curves analysis were conducted on the correlation of DS staging,ISS staging and other factors with the overall survival（ OS） and progression free survival（ PFS） of MM patients. A total of 19 patients died6 months after diagnosis,and multivariate Logistic regression analysis was employed to investigate influencing factors for early death. According to common influencing factors for OS and PFS and ISS staging,the patients were divided into three groups： high risk group,average risk group and low risk group. The prognosis of the three groups was analyzed. Results Among 202 MM patients,53（ 26. 2%） patients had CR; 96（ 47. 5%） had very good partial response（ VGPR）; 29（ 14. 4%） patients had partial remission（ PR）; the overall effective rate was 88. 1%. By the end of follow- up,120 patients died. One- year,three-year,five- year and ten- year survival rates were 80. 7%,70. 6%,36. 1% and

关 键 词：多发性骨髓瘤 预后 影响因素分析 

分 类 号：R733.3[医药卫生—肿瘤]