C-MYC表达和淋巴细胞亚群与MM预后相关性  

ASSOCIATION OF C-MYC EXPRESSION AND LYMPHOCYTE SUBSETS WITH THE PROGNOSIS OF MULTIPLE MYELOMA

作　　者：贾红霞 安立才 王蕾[1] 刘英慧[1] 初晓霞[1] JIA Hongxia;AN Licai;WANG Lei;LIU Yinghui;CHU Xiaoxia(Department of Hematology,The Affiliated Yantai Yuhangding Hospital of Qingdao University,Yantai 264000,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院血液科,山东烟台264000

出　　处：《青岛大学学报（医学版）》2022年第3期437-442,共6页Journal of Qingdao University(Medical Sciences)

基　　金：北京医卫健康公益基金会医学科学研究基金资助项目(YWJKJJHKYJJ-B19141AT)。

摘　　要：目的探讨多发性骨髓瘤(MM)病人骨髓中C-MYC的表达、外周血淋巴细胞亚群变化与预后的关系。方法采用免疫组化方法检测MM病人骨髓标本中C-MYC的表达水平,采用流式细胞术检测外周血淋巴细胞亚群,分析C-MYC表达与MM病人部分临床指标的关系,并分析C-MYC表达、淋巴细胞亚群对预后的影响。结果106例新诊断的MM病人中有38例C-MYC过表达。C-MYC过表达组MM病人乳酸脱氢酶、白细胞介素-6、β2-微球蛋白、血清钙、血红蛋白、CD4^(+)T细胞比例、CD8^(+)T细胞比例、CD4/CD8比值与C-MYC低表达组比较差异均有显著性(t=-5.992~4.690,P<0.05)。MM病人骨髓中C-MYC的表达与CD8^(+)T细胞比例呈正相关(r=0.319,P<0.05),与CD4^(+)T细胞比例、CD4/CD8比值呈负相关(r=-0.217、-0.297,P<0.05)。R-ISS分期Ⅲ期MM病人的C-MYC表达明显高于Ⅰ、Ⅱ期病人(H=32.795,Z=-4.669、-5.223,P<0.001);R-ISS分期Ⅲ期MM病人的CD4^(+)T细胞比例明显低于Ⅰ期病人(F=3.570,P<0.05),CD4/CD8比值明显低于Ⅰ、Ⅱ期病人(F=7.787,P<0.01),CD8^(+)T细胞比例明显高于Ⅰ、Ⅱ期病人(F=9.147,P<0.001)。COX回归分析显示,C-MYC过表达、CD4/CD8比值下降是影响MM预后的独立危险因素。结论MM病人骨髓中C-MYC的表达水平与外周血淋巴细胞亚群变化具有相关性,二者均是MM病人的预后影响因素,可作为预测预后的指标。Objective To investigate the association of C-MYC expression in bone marrow and changes in peripheral blood lymphocyte subsets with the prognosis of patients with multiple myeloma(MM).Methods Immunohistochemistry was used to measure the expression level of C-MYC in bone marrow specimens of MM patients,and flow cytometry was used to mea-sure peripheral blood lymphocyte subsets.The correlation of C-MYC expression with several clinical indicators was analyzed,as well as the influence of C-MYC expression and lymphocyte subsets on prognosis.Results Among the 106 patients newly diagnosed with MM,38 were found to have C-MYC overexpression.There were significant differences between the C-MYC overexpression group and the low C-MYC expression group in lactate dehydrogenase,interleukin-6,β2-microglobulin,serum calcium,hemoglobin,proportion of CD4^(+)T cells,proportion of CD8^(+)T cells,and CD4/CD8 ratio(t=-5.992 to 4.690,P<0.05).The expression of C-MYC in the bone marrow of MM patients was positively correlated with the proportion of CD8^(+)T cells(r=0.319,P<0.05)and was negatively correlated with the proportion of CD4^(+)T cells and CD4/CD8 ratio(r=-0.217,-0.297;P<0.05).The patients with R-ISS stageⅢMM had a significantly higher expression level of C-MYC than those with R-ISS stageⅠ/ⅡMM(H=32.795;Z=-4.669,-5.223;P<0.001).The patients with R-ISS stageⅢMM had a significantly lower proportion of CD4^(+)T cells than those with R-ISS stageⅠMM(F=3.570,P<0.05),as well as a significantly lower CD4/CD8 ratio(F=7.787,P<0.01)and a significantly higher proportion of CD8^(+)T cells(F=9.147,P<0.001)compared with those with R-ISS stageⅠ/ⅡMM.The COX regression analysis showed that C-MYC overexpression and reduction in CD4/CD8 ratio were independent risk factors for the prognosis of MM.Conclusion The expression level of C-MYC in bone marrow is correlated with the change of lymphocyte subsets,and both of them are the influencing factors for the prognosis of MM patients and can be used to predict prognosis.

关 键 词：多发性骨髓瘤 原癌基因蛋白质C-MYC 淋巴细胞亚群 治疗结果 预后 

分 类 号：R733.3[医药卫生—肿瘤]