LMR、PNI与多发性骨髓瘤患者化疗反应及预后的关系  

Relationship between LMR,PNI and chemotherapy response and prognosis in patients with multiple myeloma

作　　者：陈小双 高正杰 高攀科 邢瑞 韩效林[1] 李敬东[1] CHEN Xiaoshuang;GAO Zhengjie;GAO Panke;XING Rui;HAN Xiaolin;LI Jingdong(Department of Hematology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang,Henan 453100,China;不详)

机构地区：[1]新乡医学院第一附属医院血液科,河南新乡453100 [2]新乡医学院第一附属医院普通外科

出　　处：《中华全科医学》2023年第12期2022-2026,共5页Chinese Journal of General Practice

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210523)。

摘　　要：目的探讨淋巴细胞单核细胞比值(LMR)和预后营养指数(PNI)对多发性骨髓瘤(MM)患者化疗反应及预后的影响。方法选取2016年3月—2022年5月新乡医学院第一附属医院收治的MM患者243例。收集化疗前1周患者的实验室检查指标,计算LMR和PNI,并根据中位数分为低PNI组(<47.2,121例)和高PNI组(≥47.2,122例),低LMR组(<5.85,120例)和高LMR组(≥5.85,123例)。比较不同分组患者的临床资料、化疗疗效和预后差异,并对接受硼替佐米的患者进行亚组分析。结果高PNI组和低PNI组的化疗疗效差异无统计学意义(P>0.05),低LMR组和高LMR组的化疗疗效差异无统计学意义(P>0.05)。经过1~92个月随访,110例患者死亡,133例存活。低PNI组的中位总生存期(OS)较高PNI组缩短(31个月vs.39个月,χ^(2)=4.130,P<0.05),低LMR组的中位总生存期(OS)较高LMR组缩短(31个月vs.41个月,χ^(2)=10.308,P<0.01)。在接受以硼替佐米为基础的化疗方案的136患者中,低PNI组中位OS与高PNI组差异无统计学意义(30个月vs.36个月,χ^(2)=2.814,P>0.05);低LMR组的中位OS较高LMR组缩短(30个月vs.未达到,χ^(2)=7.618,P<0.05)。Cox回归分析结果显示,低PNI和低LMR是患者OS的独立危险因素。结论PNI和LMR可作为MM患者简单可靠的预后指标,可早期识别高危患者,但无法预测患者的化疗疗效。Objective To investigate the effects of lymphocyte-monocyte ratio(LMR)and prognostic nutritional index(PNI)with chemotherapy response and prognosis in patients with multiple myeloma(MM).Methods A total of 243 MM patients admitted to the First Affiliated Hospital of Xinxiang Medical University from March 2016 to May 2022 were selected.LMR and PNI were calculated.According to the median,patients were divided into PNI group(<47.2,121 cases)and high PNI group(≥47.2,122 cases),high LMR group(≥5.85,123 cases)and low LMR group(<5.85,120 cases).The clinical data,chemotherapy efficacy and prognosis of patients in different groups were compared,and subgroup analysis of patients receiving bortezomib was performed.Results There was no significant difference in the efficacy of chemotherapy between the high PNI group and the low PNI group(P>0.05),and there was no significant difference in the efficacy of chemotherapy between the low LMR group and the high LMR group(P>0.05).After 1 to 92 months of follow-up,110 patients died and 133 patients survived.The median OS of the low PNI group was shorter than that of the PNI group(31 months vs.39 months,χ^(2)=4.130,P<0.05),and the median OS of the low LMR group was shorter than that of the high LMR group(31 months vs.41 months,χ^(2)=10.308,P<0.01).Among 136 patients who received bortezomib-based chemotherapy,there was no significant difference in median OS between the low and high PNI groups(30 months vs.36 months,χ^(2)=2.814,P>0.05).The median OS of the low LMR group was shorter than that of the LMR group(30 months vs.not reached,χ^(2)=7.618,P<0.05).Cox regression analysis showed that low PNI and low LMR were independent risk factors for OS.Conclusion PNI and LMR can be used as simple and reliable prognostic indicators for MM patients.PNI and LMR can identify high-risk patients early,but cannot predict response to chemotherapy.

关 键 词：多发性骨髓瘤 淋巴细胞单核细胞比值 预后营养指数 化疗疗效 预后 

分 类 号：R733.3[医药卫生—肿瘤] R730.53[医药卫生—临床医学]