初诊多发性骨髓瘤患者的血清游离轻链对肾功能及预后的影响  

Effect of Serum Free Light Chain on Renal Function and Prognosis in Patients with Newly Diagnosed Multiple Myeloma

作　　者：陈旭端[1] 骆晓峰[2] 祖燕萍 叶洪[1] 李琳琳[1] 陈巧玲[1] 谢文珍[1] 杨婷[2] 胡建达[2] 魏立新[1] CHEN Xu-Duan;LUO Xiao-Feng;ZU Yan-Ping;YE Hong;LI Lin-Lin;CHEN Qiao-Ling;XE Wen-Zhen;YANG Ting;HU Jian-Da;WEI LI-Xin(Department of Nephrology,Fujian Medical University Union Hospital;Fujian Institute of Hematology,Fujian Provincial Key Laboratory on Hematology,Fujian Medical University Union Hospital;Department of Nephrology,Fujian Provincial Hospital Jinshan Branch,Fuzhou 350001,Fujian Province,China)

机构地区：[1]福建医科大学附属协和医院肾内科 [2]福建医科大学附属协和医院血液科,福建省血液病研究所,福建省血液病重点实验室 [3]福建省立医院金山分院肾内科,福建福州350001

出　　处：《中国实验血液学杂志》2019年第6期1862-1868,共7页Journal of Experimental Hematology

基　　金：国家自然科学基金(81700131);福建省中青年教师教育科研项目(JT180170);国家及福建省临床重点专科建设项目(闽财指(2011)1006号，闽卫科教(2012)149号);福建省血液病医学中心建设项目(闽政办(2017)4号);福建省自然科学基金(2018J01312)

摘　　要：目的:分析血清游离轻链(sFLC)对初诊多发性骨髓瘤(MM)患者肾功能及预后的影响。方法:选取并回顾性分析2012年4月至2016年11月我院收治的70例初诊MM且有行sFLC检查的患者的临床资料,将可能的肾功能损害相关危险因素及影响预后的因素进行单因素分析,通过Logistic回归分析及Kaplan-Meier生存分析等方法分析sFLC在初诊MM患者肾损害和预后中的作用。结果:70例患者中有20例发生肾功能损害,相比于肾功能正常组,肾功能损害组的血红蛋白(Hb)水平低,血尿酸(Uric acid)、校正血钙(Corrected calcium)、血肌酐(Scr)、血清β2微球蛋白(S-β2-MG)、受累sFLC(Involved sFLC)水平均高;ISS III期、受累sFLC≥500 mg/L、行血液透析的比例均明显升高(P<0.05)。多因素Logistic回归分析提示:血尿酸≥430μmol/L、ISS III期和受累sFLC≥500 mg/L均是初诊MM患者发生肾功能损害的独立危险因素(P<0.05);进一步用ROC曲线分析提示受累sFLC为705.0 mg/L,这是预测初诊MM患者发生肾损害的最佳阈值(AUC为0.727,P=0.003,敏感性为65.0%,特异性为82.0%)。患者中位随访31.0(1-84)个月,受累sFLC≥500 mg/L组和受累sFLC<500 mg/L组的中位生存期分别为27.0和52.0个月,差异无统计学意义(P=0.137);sFLC高比率组(κ/λ>32或<0.03)和低比率组(0.03≤κ/λ≤32)的中位生存期同样无显著的统计学差异(27 vs 40个月,P=0.436)。结论:初诊MM患者肾功能损害组的受累sFLC水平高于肾功能正常组,血尿酸≥430μmol/L、ISS III期和受累sFLC≥500 mg/L是初诊MM患者发生肾功能损害的独立危险因素。监测sFLC有助于肾功能损害的预测,受累sFLC的水平或sFLC比率不影响患者的预后。Objective:To analyze the effect of serum free light chain(sFLC)on renal function and prognosis in patients with newly diagnosed multiple myeloma(MM).Methods:The clinical data of 70 newly diagnosed MM patients who received sFLC examination in Fujian Medical University Union Hospital were retrospectively analyzed from April2012 to November 2016.Univariate analysis was used to analyze the risk factors that associated with renal impairment(RI)and prognosis.Logistic regression and Kaplan-Meier analyze were used to analyze the roles of sFLC in RI and the prognosis.Results:Out of the 70 patients,20 patients had RI at the initial diagnosis.Compared to normal renal function group,RI group had lower level of hemoglobin,elevated levels of serum uric acid,corrected calcium,serum creatinine,serumβ2 microglobulin,and involved sFLC,higher proportion of patients with ISS stageⅢ,involved sFLC≥500 mg/L,hemodialysis(all P<0.05).Multivariate logistic regression analysis showed that serum uric acid≥430μmol/L,ISS stageⅢand a involved sFLC≥500 mg/L were all the independent risk factors for RI in patients with newly diagnosed MM patients(all P<0.05).Receiver operating characteristic(ROC)curves analysis showed that the involved sFLC was 705.0 mg/L,which was a best cut-off value area under curve(AUC)for prediting RI in patients with MM was 0.727(P=0.003),sensitivity was 65.0%and specificity was 82.0%).After a median follow-up period of 31(1-84)months,the median overall survival(OS)of patients with involved sFLC≥500 mg/L and involved sFLC<500 mg/L were 52.0 and 27.0 months,respectively,there was no statistically significant difference(P=0.137).There was also no statistically significant difference in median OS between the high sFLC ratio group(κ/λ>32 or<0.03)and the low sFLC ratio group(0.03≤κ/λ≤32)(27 months vs 40 months,P=0.436).Conclusion:The involved sFLC in the RI group is significantly higher than that in the normal renal function group in newly diagnosed MM patients.Serum uric acid≥430μmol/L,ISS stageⅢand

关 键 词：血清游离轻链 多发性骨髓瘤 肾损害 预后 

分 类 号：R733.3[医药卫生—肿瘤] R692.5[医药卫生—临床医学]