补体C3水平对多发性骨髓瘤患者生存的影响及模型预测  

The Prognosis and Predictive Value of Complement C3 in Patients with Multiple Myeloma

作　　者：陈益飞[1] 陆益龙[2] 朱颖[1] 景传红[1] CHEN Yi-Fei;LU Yi-Long;ZHU Ying;JING Chuan-Hong(Department of Hematology,Jiangdu People's Hospital of Yangzhou,Yangzhou 225000,Jiangsu Province,China;Department of Hematology,Affiliated Hospital of Jiangsu University,Zhenjiang 212000,Jiangsu Province,China)

机构地区：[1]扬州市江都人民医院血液科,江苏扬州225000 [2]江苏大学附属医院血液科,江苏缜江212000

出　　处：《中国实验血液学杂志》2021年第3期819-826,共8页Journal of Experimental Hematology

摘　　要：目的:探讨多发性骨髓瘤(MM)患者补体C3水平对其生存预后的影响,并以此构建生存模型预测患者的长期生存。方法:回顾性分析80例初治MM患者的性别、年龄、血小板计数、白细胞数、ISS分期、FISH、患者血清kappa轻链、lammda轻链、补体C3、C4水平等指标,通过Cox回归生存分析模型,对影响患者生存的危险因素进行单因素以及多因素分析。以补体C3水平为基础,构建疾病生存预测模型(Nomogram图)。结果:MM患者平均年龄(63.15±10.41)岁,其中男36例,女44例。中位总生存期(OS)36.3个月,中位无进展生存期(PFS)35.2个月,3年OS率为67.5%,3年PFS率为52.5%。单因素分析删选变量后,纳入多因素分析,结果显示,补体C3水平≥0.7 U/L、血小板数<100×10^(9)/L为影响MM患者预后的独立危险因素。以补体C3、血小板计数以及β2微球蛋白水平构建的生存预测模型Nomogram图显示出了较好的预测准确度,其中C指数为0.775。结论:高C3水平及低血小板MM患者临床预后差,以此变量建立的生存预测模型,能够较好地预测患者长期生存,为临床治疗提供指导。Objective:To investigate the effect of complement C3 on the prognosis of patients with multiple myeloma(MM),and to establish a predictive model to evaluate the overall survival.Methods:Eighty newly diagnosed MM patients were enrolled,and clinical characteristics,such as sex,age,platelet count,white blood cell count,ISS stage,FISH,levels of kappa and lammda chain,complement C3 and C4 were retrospectively analyzed.Cox regression model was used for univariate and multivariate analysis about risk factors that affecting the prognosis of the MM patients.A nomogram based on C3 level was established for predicting the prognosis of MM patients.Results:The average age of the MM patients was 63.15±10.41,including 36 males and 44 females.The median overall survival(OS) was 36.3 months,and the median progression-free survival(PFS) was 35.2 months,the 3-year OS rate and PFS rate of the MM patients were 67.5% and 52.5%,respectively.The variants selected by univariate analysis were put into multivariate regression model,the result showed that C3 level≥0.7 U/L and PLT count <100 × 109/L were the independent risk factors for OS.Nomogram based on C3 level,PLT count as well as β2-Protein level showed an excellent accuracy in estimating prognosis of MM(C-index:0.775).Conclusion:Patients with C3 level ≥0.7 U/L or PLT count <100×10^(9)/L show poor prognosis.Nomogram based on the two variants can estimate overall survival of MM patients and provide suggestions to clinical decision.

关 键 词：多发性骨髓瘤 补体C3 生存分析 模型构建 

分 类 号：R733.3[医药卫生—肿瘤]