多发性骨髓瘤低胆固醇血症与预后相关性分析及机制  

Correlation between hypocholesterolemia and poor prognosis in multiple myeloma and a study on its mechanism

作　　者：古流芳[1] 崔晓光[1] 何爱丽[1] 曹星梅[1] 

机构地区：[1]西安交通大学第二附属医院血液内科,陕西西安710004

出　　处：《兰州大学学报（医学版）》2018年第1期48-52,共5页Journal of Lanzhou University（Medical Sciences）

摘　　要：目的分析多发性骨髓瘤(MM)患者低胆固醇血症与临床指标、临床分期、细胞遗传学异常之间的相关性,探讨低胆固醇血症发生的原因及可能机制。方法采用单因素及多因素线性分析法回顾性分析了154例确诊的MM患者血清胆固醇水平与血红蛋白、骨髓瘤细胞比例、临床分期及遗传学异常之间的相关性;采用实时荧光定量PCR检测初诊、完全缓解MM患者与胆固醇转运及胞内定位相关的低密度脂蛋白受体(LDLR)及三磷酸腺苷相关转运体ABCA1m RNA的表达水平。结果 MM患者血清胆固醇水平下降以低密度脂蛋白(LDL)和载脂蛋白B最为显著,且随疾病分期逐渐降低;胆固醇水平与患者遗传学异常具有一定相关性,荧光原位杂交技术(FISH)检测1q21扩增和p53缺失患者血清胆固醇水平显著低于FISH阴性的患者。LDLR m RNA在初诊和复发MM患者中的表达水平明显高于完全缓解组及对照组(P=0.001),而ABCA1 m RNA在各组间无统计学差异。结论 MM患者胆固醇降低的水平与临床分期、遗传学异常相关;MM患者的低胆固醇血症可能与LDL摄入增加有关,而胆固醇逆向转运并无显著变化。Objective To analyze the correlation between low cholesterol and clinical indicators and prognostic factors in MM patients and explore the possible causes of hypercholesterolemia in MM patients. Methods A retrospective analysis was made of the correlation between the serum cholesterol level and tumor cell propor- tion in bone marrow and clinical risk stratification in 154 MM patients using univariate and multivariate linear method. The expression of LDLR and ABCA1 mRNA were detected by real-time fluorescence quantitative PCR in MM patients. Results The level of serum cholesterol in patients with MM decreased significantly and the level of LDL and Apo B decreased significantly too, which deteriorated with the stages of disease. The level of cholesterol decreased significantly in patients with genetic abnormalities 1q21 and p53 deletion. The expression level of LDLR mRNA in the newly diagnosed and relapsed MM patients was significantly higher than that in the complete remission group and the control group （P=-0.001）, while there was no significant difference in ABCA1 mRNA between the groups. Conclusion Hypocholesterolemia in MM patients is related to the deterioration of disease. The hypocholesterolemia of MM patients may be related to the increase ofLDL intake and the mechanism of hypocholesterolemia in MM deserves further study.

关 键 词：多发性骨髓瘤 低胆固醇血症 预后 

分 类 号：R453.9[医药卫生—治疗学]