胱抑素C与β2-微球蛋白在多发性骨髓瘤病情及近期疗效评估中的应用  

Application of cystatin C and β2-microglobulin in the assessment of condition and short-term efficacy of multiple myeloma

作　　者：张蕴玉 彭静 宋志刚[1] 李星缘 Zhang Yunyu;Peng Jing;Song Zhigang;Li Xingyuan(Department of Oncology Hematology,Anqing Hospital of Chinese People′s Liberation Army Navy,Anqing 246000,China;Department of Hematology,Jinhua Central Hospital,Zhejiang Province,Jinhua 321000,China)

机构地区：[1]解放军海军安庆医院肿瘤血液科,安庆246000 [2]浙江省金华市中心医院血液科,321000

出　　处：《国际肿瘤学杂志》2019年第10期590-594,共5页Journal of International Oncology

摘　　要：目的探讨血清中胱抑素C(Cys-C)与β2-微球蛋白(β2-MG)在多发性骨髓瘤(MM)病情诊断及近期疗效评估中的应用价值。方法选取解放军海军安庆医院和浙江省金华市中心医院2016年10月至2018年10月收治的450例MM患者作为研究对象(MM组),依据Durie-Salmon分期标准,Ⅰ期、Ⅱ期、Ⅲ期患者各150例;选取同期体检的健康者150例作为对照组。测定受试者血清中Cys-C和β2-MG水平。比较两组人员、Durie-Salmon不同分期MM患者血清Cys-C和β2-MG水平差异;比较不同疗效MM患者的Cys-C和β2-MG水平差异;采用受试者工作特征(ROC)曲线分析该两项指标在MM疗效评估中的价值,分析Cys-C与β2-MG水平的相关性,logistic回归分析影响MM患者临床疗效的因素。结果MM组患者血清Cys-C、β2-MG水平分别为(2.11±0.78)mg/L、(6.07±3.08)g/L,对照组分别为(0.75±0.20)mg/L、(1.78±0.59)g/L,两组间Cys-C、β2-MG水平比较,差异均具有统计学意义(t=33.848,P<0.001;t=28.084,P<0.001)。Durie-SalmonⅠ期、Ⅱ期、Ⅲ期患者血清Cys-C水平分别为(0.99±0.21)mg/L、(1.36±0.17)mg/L、(3.07±1.02)mg/L,差异具有统计学意义(F=44.157,P<0.001);Ⅰ期、Ⅱ期、Ⅲ期患者血清β2-MG水平分别为(2.57±0.75)g/L、(4.66±1.43)g/L、(8.63±2.26)g/L,差异具有统计学意义(F=57.285,P<0.001)。MM患者治疗有效338例,占75.11%;无效112例,占24.89%。有效患者血清Cys-C、β2-MG水平分别为(1.28±0.23)mg/L、(2.82±0.78)g/L,无效患者分别为(2.97±0.77)mg/L、(6.22±1.92)g/L,差异均具有统计学意义(t=35.874,P<0.001;t=26.633,P<0.001)。血清Cys-C近期疗效预测敏感性为83.0%、特异性为76.6%,血清β2-MG预测敏感性为89.3%、特异性为73.6%;血清Cys-C曲线下面积(AUC)为0.813,95%CI为0.764~0.862;血清β2-MG AUC为0.865,95%CI为0.825~0.906,两组AUC比较,差异具有统计学意义(Z=2.490,P=0.011)。Spearman相关性分析显示血清中Cys-C与β2-MG水平呈正相关(r=0.539,P=0.041)。logistic回归分析显示β2-MG(95%CObjective To explore the application value of serum cystatin C(Cys-C)andβ2-microglobulin(β2-MG)in the diagnosis and short-term efficacy evaluation of multiple myeloma(MM).Methods A total of 450 patients with MM admitted to Anqing Hospital of Chinese People′s Liberation Army Navy and Jinhua Central Hospital of Zhejiang Province from October 2016 to October 2018 were selected as subjects(MM group),according to the Durie-Salmon staging criteria,including 150 patients in stageⅠ,ⅡandⅢ.A total of 150 healthy subjects were selected as the control group.The levels of Cys-C andβ2-MG in the serum of the subjects were determined.The differences of Cys-C andβ2-MG levels between the two groups and the MM patients with different Durie-Salmon stages were compared.The differences of Cys-C andβ2-MG levels between the patients with different short-term efficacy were compared.The receiver operating characteristic(ROC)curve was used to analyze the value of the two indicators in the evaluation of MM efficacy,and the correlation between Cys-C andβ2-GM was analyzed.Logistic regression analysis was used to analyze the multiple factors affecting the clinical efficacy of MM patients.Results The levels of Cys-C andβ2-MG in the serum of the patients with MM were(2.11±0.78)mg/L and(6.07±3.08)g/L respectively,and those in the control group were(0.75±0.20)mg/L and(1.78±0.59)g/L,with significant differences(t=33.848,P<0.001;t=28.084,P<0.001).The Cys-C levels of Durie-Salmon stageⅠ,ⅡandⅢpatients were(0.99±0.21)mg/L,(1.36±0.17)mg/L and(3.07±1.02)mg/L respectively,and the difference was statistically significant(F=44.157,P<0.001).Theβ2-MG levels in the serum of patients with stageⅠ,ⅡandⅢwere(2.57±0.75)g/L,(4.66±1.43)g/L,(8.63±2.26)g/L respectively,and the difference was statistically significant(F=57.285,P<0.001).In all the patients,338 patients were effective,accoun-ting for 75.11%,and 112 patients were ineffective,accounting for 24.89%.The levels of Cys-C andβ2-MG in the serum of the effective MM patients w

关 键 词：多发性骨髓瘤 诊断 治疗结果 胱抑素-C Β2-微球蛋白 

分 类 号：R733[医药卫生—肿瘤]