血清游离轻链比值对初诊多发性骨髓瘤的预后评估价值  

Significance of serum free light chain ratio for prognosis of newly diagnosed multiple myeloma

作　　者：强琬婷 罗添丞 卢静[1] 贺婕[1] 李璐[1] 李荣[1] 陈小梅 赵云阳[1] 姜华[1] 傅卫军[1] 杜鹃[1] QIANG Wanting;LUO Tiancheng;LU Jing;HE Jie;LI Lu;LI Rong;CHEN Xiaomei;ZHAO Yunyang;JIANG Hua;FU Weijun;DU Juan(Department of Hematology,The Myeloma&Lymphoma Center,Changzheng Hospital,Second Military Medical University,Shanghai 200003,China)

机构地区：[1]第二军医大学长征医院血液科&全军骨髓瘤与淋巴瘤疾病中心

出　　处：《临床检验杂志》2019年第11期848-852,共5页Chinese Journal of Clinical Laboratory Science

摘　　要：目的观察血清游离轻链(sFLC)对初诊多发性骨髓瘤(MM)患者预后的影响。方法回顾性分析2010年6月至2016年12月第二军医大学长征医院收治的621例初诊MM患者的临床资料,用免疫比浊法检测sFLCκ、λ的表达水平,分析初诊时血清游离轻链比值(serum free light chain ratio,sFLCR)在MM患者预后中的作用。结果初诊MM患者621例,其中sFLCR正常组(0.26≤sFLCR≤1.65)42例(6.8%),sFLCR低组(0.01<sFLCR<0.26或1.65<sFLCR<100)247例(39.8%),sFLCR高组(sFLCR≤0.01或sFLCR≥100)332例(53.4%)。sFLCR异常组与正常组相比,患者初诊时血红蛋白降低,浆细胞比例、血肌酐、β2微球蛋白(β2MG)均增高,合并细胞遗传学高危、DSⅢ期、ISSⅢ期患者均增多(P均<0.05)。预后生存比较中,sFLCR异常组患者中位总生存(OS)时间较正常组患者缩短(58.7月vs未达到,P=0.043)。Cox预后风险回归示,sFLCR异常和细胞遗传学高危均可作为MM的独立预后因素,且sFLCR高组合并细胞遗传学高危组患者预后更差,中位OS时间41.6个月,较合并细胞遗传学标危组患者中位OS时间61.4个月缩短(P=0.015)。结论初诊时sFLCR异常的MM患者肿瘤负荷高、侵袭性强,其中伴有细胞遗传学高危的MM患者预后更差,sFLCR可作为MM的独立预后因素。Objective To analyze the significance of serum free light chain(sFLC)for the prognosis of the patients with newly diagnosed multiple myeloma(NDMM).Methods The clinical data of 621 NDMM patients in Changzheng Hospital from June 2010 to December 2016 was retrospectively analyzed.The serum free light chain levels were measured and the ratios ofκ/λchains were calculated.The significance of serum free light chain ratio(sFLCR)for the prognosis of NDMM patients was analyzed.Results Among the 621 NDMM patients,42 patients(6.8%)were in the normal free light chain ratio group(0.26≤sFLCR≤1.65),247 patients(39.8%)were in the low free light chain ratio group(0.01<sFLCR<0.26 or 1.65<sFLCR<100),and 332 patients(53.5%)were in the high free light chain ratio group(sFLCR≤0.01 or sFLCR≥100).Compared with normal sFLCR group,the abnormal sFLCR group showed low level of hemoglobin;elevated levels of bone marrow plasma cells,serum creatinine andβ2MG,and more patients were in DS stageⅢand ISS stageⅢwith high risks of cytogenetics(all P<0.05).The overall survival(OS)in the normal sFLCR group was significantly better than the abnormol sFLCR groups(not reached vs 58.7 months,P=0.043).Compared with the patients with both high sFLCR and low risks of cytogenetics,the patients with high sFLCR and high risks of cytogenetics showed shorter overall survival time(median OS time was 41.6 months vs 61.4 months,P=0.015).Conclusion The NDMM patients with significantly abnormal sFLCR may indicate more tumor load and higher aggressive progression.sFLCR should be an independent prognostic indicator for the outcome of multiple myeloma.The patients with high sFLCR and cytogenetic abnormalities,have worse prognosis than the others.

关 键 词：血清游离轻链 血清游离轻链比值 多发性骨髓瘤 预后 

分 类 号：R446[医药卫生—诊断学]