血清CXCL9和IL-34水平检测对多发性骨髓瘤患者的疗效监测及其预后价值  

Serum CXCL9 and IL-34 Levels in Multiple Myeloma Patients for Monitoring Efficacy and Prognostic Value

作　　者：任梅 石培民[1] 谢静[1] 季国 李娟[1] 叶春美[1] 许荟 REN Mei;SHI Peimin;XIE Jing;JI Guo;LI Juan;YE Chunmei;XU Hui(Department of Hematology,Taixing People’s Hospital,Anhui Fuyang 236000,China)

机构地区：[1]泰兴市人民医院血液内科,安徽阜阳236000

出　　处：《现代检验医学杂志》2023年第5期127-132,共6页Journal of Modern Laboratory Medicine

基　　金：泰兴市人民医院资助项目(编号:try1914):铁代谢相关指标在缺铁性贫血及慢性贫血诊断中的应用价值。

摘　　要：目的探讨C-X-C基序趋化因子配体9(C-X-C motif chemokine ligand 9,CXCL9)和白细胞介素-34(interleukin-34,IL-34)在多发性骨髓瘤(multiple myeloma,MM)患者血清中的表达及其诊断、疗效监测、预后诊断价值。方法选取2017年6月~2019年1月在泰兴市人民医院进行治疗的MM患者101例为研究组,另纳入进行健康体检的志愿者95例为对照组。采用酶联免疫法检测CXCL9和IL-34水平;利用受试者工作特征(receiver operating characteristic,ROC)曲线评价血清CXCL9和IL-34水平对MM的诊断价值;利用Kaplan-Meier法分析MM患者血清中CXCL9和IL-34表达与患者生存时间的关系;采用多因素COX回归风险模型分析影响MM患者预后的因素。结果与对照组比较,MM患者血清中CXCL9(950.56±180.11 pg/ml vs 273.03±50.19 pg/ml)和IL-34(15.53±4.26 pg/ml vs 3.05±0.81 pg/ml)表达水平升高,差异具有统计学意义(t=35.391,28.077,均P<0.05);与化疗前比较,治疗获益组化疗后患者血清CXCL9(341.21±44.76 pg/ml vs 923.21±175.78 pg/ml)和IL-34表达水平(4.21±0.59 pg/ml vs 14.96±4.10 pg/ml)下降,差异具有统计学意义(t=44.746,32.924,均P<0.05);治疗未获益组化疗后患者血清CXCL9(774.83±169.45 pg/ml vs 999.95±187.93 pg/ml)和IL-34表达水平(12.17±3.65 pg/ml vs16.57±4.55 pg/ml)下降,差异具有统计学意义(t=13.692,11.365,均P<0.05);与治疗未获益组相比,治疗获益组患者化疗后血清中CXCL9,IL-34表达水平均较低(t=19.508,17.247,均P<0.05);MM患者血清中CXCL9和IL-34表达与D-S分期、ISS,R-ISS,乳酸脱氢酶(lactate dehydrogenase,LDH)、清蛋白和血钙有关(t=3.029~7.219,均P<0.05);ROC结果显示,CXCL9和IL-34诊断MM患者的曲线下面积(area under curve,AUC)分别为0.841,0.869;对应的敏感度分别为92.08%,84.16%;特异度分别为83.16%,91.58%。二者联合诊断MM患者的AUC为0.915,对应的敏感度和特异度分别为94.06%,74.74%;Kaplan-Meier分析结果显示,CXCL9低表达组患者三年累积生存率81.40%(35/43)显著高于高Objective To investigate the expression of C-X-C motif chemokine ligand 9(CXCL9)and interleukin-34(IL-34)in the serum of patients with multiple myeloma(MM)and their diagnostic value in diagnosis,efficacy monitoring and prognosis.Methods A total of 101 patients with MM who were treated in Taixing People’s Hospital from June 2017 to January 2019 were selected as the study group,and 95 volunteers for physical examination were selected as the control group.The levels of CXCL9 and IL-34 were detected by ELISA,the diagnostic value of CXCL9 and IL-34 in serum for MM was evaluated by ROC curve.Kaplan-Meier method was used to analyze the relationship between the expression of CXCL9,IL-34 and the survival time of MM patients.Multivariate COX regression risk model was applied to analyze the factors affecting the prognosis of MM patients.Results Compared with the control group,the serum levels of CXCL9(950.56±180.11 pg/ml vs 273.03±50.19 pg/ml)and IL-34(15.53±4.26 pg/ml vs 3.05±0.81 pg/ml)in MM patients were increased,the difference was statistically significant(t=35.391,28.077,all P<0.05).Compared with before chemotherapy,serum CXCL9(341.21±44.76 pg/ml vs 923.21±175.78 pg/ml)and IL-34 expression levels(4.21±0.59 pg/ml vs 14.96±4.10 pg/ml)decreased in patients in the treatment-benefited group after chemotherapy,with statistically significant differences(t=44.746,32.924,all P<0.05),and serum CXCL9(774.83±169.45pg/ml vs 999.95±187.93pg/ml)and IL-34 expression levels(12.17±3.65pg/ml vs 16.57±4.55pg/ml)decreased in patients in the treatment-naive group after chemotherapy,with statistically significant difference(t=13.692,11.365,all P<0.05).Serum expression levels of CXCL9 and IL-34 were lower in patients in the treatment-benefit group after chemotherapy compared to the treatment-naive group(t=19.508,17.247,all P<0.05).The expression of CXCL9 and IL-34 in serum of MM patients was related to D-S stage,ISS,R-ISS,lactate dehydrogenase(LDH),serum albumin and serum calcium(t=3.029~7.219,all P<0.05).ROC results showed

关 键 词：多发性骨髓瘤 C-X-C基序趋化因子配体9 白细胞介素-34 

分 类 号：R733.3[医药卫生—肿瘤] R730.43[医药卫生—临床医学]