多发性骨髓瘤患者化疗后近期病死的影响因素及外周血Th17/Treg、NLR对化疗后近期病死的预测价值  

Influencing factors for post-chemotherapy short-term mortality in patients with multiple myeloma and predictive value of peripheral blood Th17/Treg,NLR on post-chemotherapy short-term mortality

作　　者：余方方 吴艳秋 黄翠 李定富 YU Fangfang;WU Yanqiu;HUANG Cui;LI Dingfu(Department of Laboratory Medicine,West Central Hospital of Hainan,Danzhou 571700,Hainan,China)

机构地区：[1]海南西部中心医院检验科,海南省儋州市571700

出　　处：《广西医学》2023年第2期129-133,共5页Guangxi Medical Journal

基　　金：海南省卫生健康行业科研项目(19A200152)。

摘　　要：目的探讨多发性骨髓瘤(MM)患者化疗后近期病死的影响因素,并分析Th17/调节性T淋巴细胞(Treg)比值(Th17/Treg)及中性粒细胞/淋巴细胞比值(NLR)对MM患者化疗后近期病死的预测价值。方法选取接受PAD方案(硼替佐米+地塞米松+阿霉素)化疗的51例MM患者,共治疗3个疗程。3个疗程结束后随访患者1年,根据其病死情况分为病死组与生存组,比较两组患者的一般临床资料、血液生化指标[血红蛋白水平、血清钙水平、血清缺氧诱导因子1α(HIF-1α)水平、血清程序性死亡配体1(PD-L1)水平及外周血Th17/Treg、NLR]。分析MM患者外周血Th17/Treg与NLR的相关性。采用多因素Logistic回归模型分析MM患者化疗后1年内病死的影响因素。采用受试者工作特征(ROC)曲线分析外周血Th17/Treg、NLR预测MM患者化疗后1年内病死的效能。结果随访1年内,51例MM患者中共有10例(19.61%)死亡。病死组患者血清HIF-1α、PD-L1水平,以及外周血Th17/Treg、NLR均高于生存组(均P<0.05)。MM患者外周血Th17/Treg与NLR呈正相关(P<0.05)。多因素Logistic回归分析结果显示,血清HIF-1α、PD-L1水平,以及外周血Th17/Treg、NLR是MM患者化疗后1年内病死的影响因素(均P<0.05)。ROC结果显示,外周血Th17/Treg、NLR单独及二者联合预测MM患者化疗后1年内病死的曲线下面积分别为0.755、0.737、0.818。结论血清HIF-1α、PD-L1水平升高,以及外周血Th17/Treg、NLR升高的MM患者化疗后1年内病死风险增加。外周血Th17/Treg、NLR单独及二者联合对MM患者化疗后1年内病死情况均具有良好的预测效能,以二者联合预测效能最高。Objective To explore the influencing factors for post-chemotherapy short-term mortality in patients with multiple myeloma(MM),and to analyze the predictive value of Th17-to-regulatory T lymphocyte ratio(Th17/Treg)and neutrophils-to-lymphocytes ratio(NLR)on short-term mortality in MM patients after chemotherapy.Methods A total of 51 MM patients receiving PAD regimen(bortezomib+dexamethasone+adriamycin)for chemotherapy were selected,all patients received 3 courses of treatment.After 3 treatment courses,patients received follow-up for 1 year,and they were assigned to mortality group or survival group according to mortality conditions.The general clinical data,blood biochemical indices in terms of hemoglobin level,serum calcium level,serum hypoxia inducible factor 1α(HIF-1α)level,serum programmed death ligand 1(PD-L1)level,and peripheral blood Th17/Treg and NLR were compared between the two groups.The correlation of peripheral blood Th17/Treg with NLR in MM patients was analyzed.The influencing factors for mortality within 1 year after chemotherapy in MM patients were analyzed by the multivariate Logistic regression model.The efficiency of peripheral blood Th17/Treg and NLR for predicting mortality within 1 year after chemotherapy in MM patients was analyzed by the receiver operating characteristic(ROC)curve.Results Within 1 year of follow-up,among 51 MM patients,a total of 10(19.61%)patients died.The mortality group yielded higher levels of serum HIF-1α,PD-L1,and higher peripheral blood Th17/Treg and NLR as compared with the survival group(all P<0.05).Peripheral blood Th17/Treg positively correlated with NLR of MM patients(P<0.05).The results of multivariate Logistic regression analysis revealed that serum HIF-1α and PD-L1 levels,and peripheral blood Th17/Treg,NLR were the influencing factors for mortality within 1 year after chemotherapy in MM patients(all P<0.05).ROC results implied that the areas under the curve of peripheral blood Th17/Treg and NLR for alone and jointly predicting mortality within 1 year aft

关 键 词：多发性骨髓瘤 化疗 病死 影响因素 辅助性T淋巴细胞17 调节性T淋巴细胞 中性粒细胞/淋巴细胞比值 预测效能 

分 类 号：R733.3[医药卫生—肿瘤]