纤维蛋白原、乳酸脱氢酶与白蛋白比值对初诊多发性骨髓瘤患者疗效的预测价值  

Predictive value of the fibrinogen,lactate dehydrogenase to albumin ratio on the efficacy of newly diagnosed patients with multiple myeloma

作　　者：贺建林 梁晶晶 杨柳 任娟[1] 杨林花[1] HE Jianlin;LIANG Jingjing;YANG Liu;REN Juan;YANG Linhua(Department of Hematology,the Second Hospital of Shanxi Medical University,Taiyuan,030001,China;The School of Public Health,Shanxi Medical University)

机构地区：[1]山西医科大学第二医院血液科,太原030001 [2]山西医科大学公共卫生学院

出　　处：《临床血液学杂志》2023年第5期332-337,共6页Journal of Clinical Hematology

摘　　要：目的:探讨纤维蛋白原与白蛋白比值(fibrinogen to albumin ratio,FAR)和乳酸脱氢酶与白蛋白比值(lactate dehydrogenase to albumin ratio,LAR)对初诊多发性骨髓瘤(multiple myeloma,MM)患者疗效的预测价值,为临床提供参考。方法:收集108例初诊为MM的患者首次治疗前的相关临床资料、实验室指标、治疗方案和完成4个疗程的疗效,绘制受试者工作特征(ROC)曲线,计算FAR、LAR的最大曲线下面积(AUC)和最佳截断值,比较高FAR组与低FAR组、高LAR组与低LAR组患者的临床特征。采用t检验及秩和检验比较2组的FAR、LAR值。采用Cox比例风险回归模型进行单因素和多因素分析。结果:108例初诊MM患者中缓解组82例(完全缓解21例、非常好的部分缓解18例、部分缓解43例),未缓解组26例(疾病稳定11例、疾病进展15例)。根据ROC曲线分析得到FAR、LAR的最大AUC分别为0.729(95%CI 0.626~0.832)、0.720(95%CI 0.601~0.838),提示对初诊MM疗效有较好的预测价值,最佳截断值分别为0.075、6.720。高FAR组与低FAR组白蛋白(ALB)比较差异有统计学意义(P=0.001)。高LAR组与低LAR组血红蛋白(P=0.006)、乳酸脱氢酶(LDH)(P<0.001)比较差异有统计学意义。完成4个疗程后缓解组的FAR、LAR水平均显著低于未缓解组,2组比较差异有统计学意义(P<0.05)。单因素分析显示,2组间LDH、ISS分期、骨髓浆细胞百分比、FAR、LAR比较差异有统计学意义(P<0.05)。多因素分析显示,高FAR是影响初诊MM疗效的独立危险因素(HR=8.020,95%CI 1.072~60.032,P=0.043)。结论:初诊MM患者高FAR提示治疗缓解不佳,可作为初诊MM疗效的预测指标,为个体化治疗提供依据。Objective To explore the predictive value of the fibrinogen to albumin ratio(FAR)and lactate dehydrogenase to albumin ratio(LAR)on the efficacy of patients with newly diagnosed multiple myeloma(MM),so as to provide reference for clinical treatment.Methods A total of 108 patients with newly diagnosed MM were included.The relevant clinical data,laboratory indicators before their first treatment,the treatment regimens and the efficacy of completing the four courses of chemotherapy were collected.ROC curve was drawn to calculate the maximum area under curve(AUC)and optimum cut-off values of FAR and LAR.The clinical features of high FAR group and low FAR group,high LAR group and low LAR group were compared.T test and rank sum test were used to compare the FAR and LAR of the two groups.Cox proportional hazard regression model was used for univariate and multivariate analyses.Results Among 108 newly diagnosed MM patients,82 cases in remission group(CR 21 cases,VGPR 18 cases,PR 43 cases),and 26 cases in non-remission group(SD 11 cases,PD 15 cases).According to ROC curve analysis,the maximum AUCs of FAR and LAR were 0.729(95%CI 0.626-0.832)and 0.720(95%CI 0.601-0.838),suggesting that they have good predictive value for the efficacy in newly diagnosed MM.The optimum cut-off values were 0.075 and 6.720,respectively.There was a statistically significant difference in albumin(ALB)between high FAR group and low FAR group(P=0.001).There were significant differences in hemoglobin(P=0.006)and lactate dehydrogenase(LDH)(P<0.001)between high LAR group and low LAR group.After completing the four courses of chemotherapy,the levels of FAR and LAR in the remission group were significantly lower than those in the non-remission group,and the difference between the two groups was statistically significant(P<0.05).Univariate analysis showed that there were significant differences in LDH,ISS stage,bone marrow plasma cells percentage,FAR and LAR between the two groups(P<0.05).Multivariate analysis showed that high FAR was an independent risk

关 键 词：多发性骨髓瘤 纤维蛋白原与白蛋白比值 乳酸脱氢酶与白蛋白比值 疗效 

分 类 号：R733.3[医药卫生—肿瘤]