免疫炎性指标和淋巴细胞亚群在初诊多发性骨髓瘤预后判断中的意义  

Significance of immuno-inflammatory indexes and lymphocyte subsets in the prognosis of newly diagnosed multiple myeloma

作　　者：安然 陈钰[1] 张苏江[1] 严泽莹[1] 王莹[1] 刘之茵[1] 孙海敏 陈玉宝[1] AN Ran;CHEN Yu;ZHANG Sujiang;YAN Zeying;WANG Ying;LIU Zhiyin;SUN Haimin;CHEN Yubao(Department of Hematology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,201800,China)

机构地区：[1]上海交通大学医学院附属瑞金医院血液科,上海201800

出　　处：《临床血液学杂志》2022年第3期168-173,共6页Journal of Clinical Hematology

基　　金：上海交通大学医学院附属瑞金医院院基金(No:2020ZY08)。

摘　　要：目的:探讨免疫炎性指标和淋巴细胞亚群在初诊多发性骨髓瘤(NDMM)患者预后判断中的作用。方法:回顾性分析2018年6月—2019年12月我院血液科收治的NDMM患者的临床资料,包括免疫炎性指标中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞/单核细胞比值(LMR)、血小板/淋巴细胞比值(PLR)以及不同淋巴细胞亚群水平,对其临床特征、治疗反应和预后情况进行分析。结果:(1)共纳入70例NDMM患者,中位发病年龄64(37~78)岁,男女比例1.9∶1.0;不同ISS及R-ISS分期的患者LMR水平比较差异有统计学意义(P=0.018、0.004),而NLR、PLR及外周血淋巴细胞亚群水平比较差异无统计学意义。(2)分别以各免疫炎性指标的中位数作为cut-off值将患者分为高低2组,结果显示高NLR组总缓解率明显低于低NLR组(54.3%vs 82.9%,P=0.010),而高LMR组、高CD3^(+)T细胞表达组及高NK细胞表达组总缓解率分别为91.4%、80.6%及82.9%,明显高于低水平组的45.9%、55.9%及54.3%(P<0.001、P=0.026和P=0.010)。(3)70例患者的疗效均可评估,总缓解率为68.6%(48/70),19例疾病进展患者中8例使用以达雷妥尤单抗为基础的联合化疗,结果显示达雷妥尤单抗治疗前后外周血淋巴细胞亚群变化差异无统计学意义。(4)单因素分析显示,ISS分期、R-ISS分期、β2-微球蛋白、LMR、PLR、CD3^(+)CD8^(+)百分比、CD4/CD8比值是患者总生存的影响因素(P<0.05);多因素分析显示,R-ISS分期(HR=8.001,95%CI 2.222~28.812,P=0.001)、CD4/CD8比值(HR=3.875,95%CI 1.005~14.946,P=0.049)是影响患者总生存的独立危险因素。(5)根据患者伴有不良预后因素的免疫指标(LMR、PLR、CD3^(+)CD8^(+)百分比、CD4/CD8比值)个数,将患者分为伴有0或1个、2个和≥3个预后不良因素组,3组间总生存时间比较差异有统计学意义(P=0.0003)。结论:免疫炎性指标和外周血淋巴细胞亚群可反映机体免疫状态,在一定程度上对NDMM患者的预后判断有价值,值得临床深�Objective:To explore the role of immuno-inflammatory indexes and lymphocyte subsets in the prognosis of newly diagnosed multiple myeloma(NDMM)patients.Methods:The clinical characteristics,including immuno-inflammatory indexes neutrophil/lymphocyte ratio(NLR),lymphocyte/monocyte ratio(LMR),platelet/lymphocyte ratio(PLR)and different lymphocyte subsets,treatment response and prognosis of NDMM patients admitted to our hospital from June 2018 to December 2019 were retrospectively analyzed.Results:(1)The median age of 70 NDMM patients was 64(37-78)years,and the male to female ratio was 1.9∶1.0.The LMR levels of patients with different ISS and R-ISS stages were significantly different(P=0.018,0.004,respectively),while there were no significant differences in NLR,PLR and lymphocyte subsets.(2)Patients were divided into high and low groups with the median of each immuno-inflammatory index as a cut-off value,respectively.The overall remission rate(ORR)in the high NLR group was significantly lower than that in the low NLR group(54.3%vs 82.9%,P=0.010).The ORR in the high LMR group,high CD3^(+)T cell expression group and high NK cell expression group were 91.4%,80.6%,and 82.9%,significantly higher than 45.9%,55.9%,and 54.3%in the low group(P<0.001,P=0.026,P=0.010).(3)The curative effect of 70 patients was evaluable,and the ORR was 68.6%(48/70).Eight cases of the 19 patients with disease progression were treated with combination chemotherapy based on daratumumab,and there was no significant difference in the changes of lymphocyte subsets before and after treatment with daratumumab.(4)The univariate analysis revealed that ISS stage,R-ISS stage,β2-microglobulin,LMR,PLR,CD3^(+)CD8^(+)percentage,and CD4/CD8 ratio were the risk factors for the overall survival of patients with NDMM(P<0.05).The multivariate analysis revealed that R-ISS stage(HR=8.001,95%CI 2.222-28.812,P=0.001),CD4/CD8 ratio(HR=3.875,95%CI 1.005-14.946,P=0.049)were the independent risk factors for the overall survival of patients with NDMM.(5)Patients were divid

关 键 词：免疫炎性指标 淋巴细胞亚群 免疫功能 多发性骨髓瘤 预后 

分 类 号：R733.3[医药卫生—肿瘤]