IgG重/轻链比值对IgG型多发性骨髓瘤伴肾损伤化疗患者生存的预测  

Prediction of IgG heavy/light chain ratio on survival of IgG multiple myeloma patients with renal injury undergoing chemotherapy

作　　者：刘小慧[1] 刘燕飞 纪国超[1] 杨若林 李志春[1] LIU Xiao-hui;LIU Yan-fei;JI Guo-chao;YANG Ruo-lin;LI Zhi-chun(Institute of Hematology,Puyang People's Hospital,Puyang,Henan 457000,China)

机构地区：[1]濮阳市人民医院血液病研究所,河南濮阳457000

出　　处：《医药论坛杂志》2023年第21期20-27,共8页Journal of Medical Forum

摘　　要：目的探讨免疫球蛋白G(IgG)重/轻链(HLC)比值在IgG型多发性骨髓瘤(MM)伴肾损伤患者中的表达,并分析其对患者化疗生存的预测价值。方法对2018年7月—2020年7月濮阳市人民医院收治的122例IgG型MM伴肾损伤患者进行前瞻性队列研究,入院后均参照《中国多发性骨髓瘤诊治指南(2017年修订)》接受规范性治疗,对首次疗效评估为微小缓解以上患者进行为期2年的随访,同时检测上述患者化疗前、首次疗效评估时IgG的HLC比值及一般资料及化疗前其他实验室指标,观察不同HLC比值表达的IgG型MM伴肾损伤患者生存情况;同时分析不同生存状况患者HLC比值变化情况及分析影响患者预后的危险因素。结果122例患者中24例首次进行疗效评估时为微小缓解或疾病稳定或疾病进展,5例失访,3例中途放弃治疗,均给予剔除。最终93例IgG型MM伴肾损伤患者纳入本次研究。不同治疗效果患者化疗前HLC比值异常率比较,差异无统计学意义(P>0.05);化疗后,完全缓解者HLC比值异常率低于非常好的缓解、部分缓解者,且非常好的缓解HLC比值异常率低于部分缓解者(P<0.05)。以首次进行疗效评估时HLC比值进行分组,正常65例,异常28例。HLC比值异常组化疗前血清尿素氮(BUN)、β2-微球蛋白(β2-MG)、乳酸脱氢酶(LDH)水平均高于正常组(P<0.05);HLC比值异常患者2年生存时间(18.12±1.07)个月,低于正常表达患者(23.12±0.31)个月(χ^(2)=25.555,P<0.001)。随访2年,24例病死,病死率为25.81%,病死组ISS分期程度、化疗前血清BUN、β2-MG水平及游离轻链比值(rFLC)异常占比均高于正常组(P<0.05);病死组化疗前后HLC比值表达比较,差异无统计学意义(P>0.05);存活组化疗后HLC比值异常低于化疗前(P<0.05);Cox回归分析显示,ISS分期、化疗前BUN与β2-MG过表达、rFLC异常及化疗后HLC比值异常是IgG型MM伴肾损伤患者病死的独立危险因素(P<0.05)。结论HLC比值与IgG型MM伴�Objective To investigate the expression of immunoglobulin G(IgG)heavy/light chain(HLC)ratio in IgG multiple myeloma(MM)patients with renal injury,and analyze its predictive value for the survival of patients undergoing chemotherapy.Methods A prospective cohort study was conducted on 122 patients with IgG MM with renal injury who were admitted to the Puyang People's Hospital from July 2018 to July 2020.After admission,they were treated according to the Guidelines for the Diagnosis and Treatment of Multiple Myeloma in China(2017 Revision).Patients with minimal remission after the first evaluation of efficacy were followed up for 2 years.At the same time,the HLC ratio of IgG before chemotherapy and at the first evaluation of efficacy,general data and other laboratory indicators before chemotherapy were detected to observe the survival of IgG MM with renal injury patients with different HLC ratio expression.At the same time,the changes of HLC ratio in patients with different survival conditions and the risk factors affecting the prognosis were analyzed.Results Among the 122 patients,24 patients showed slight remission or stable disease or disease progression when the efficacy was evaluated for the first time,5 patients lost the follow-up,and 3 patients gave up treatment midway,all of which were excluded.Finally,93 IgG MM patients with renal injury were included in this study.There was no statistical significant difference in the abnormal rate of HLC ratio before chemotherapy in patients with different therapeutic effects(P>0.05).After chemotherapy,the abnormal rate of HLC ratio in complete remission was lower than that of very good remission and partial remission,and the abnormal rate of HLC ratio in very good remission was lower than that of partial remission(P<0.05).According to the HLC ratio at the time of the first efficacy evaluation,65 cases were normal and 28 cases were abnormal.The levels of serum urea nitrogen(BUN),β2-microglobulin(β2-MG)and LDH in abnormal HLC ratio group before chemotherapy were higher t

关 键 词：多发性骨髓瘤 肾损害 免疫球蛋白G 重/轻链比值 

分 类 号：R733.3[医药卫生—肿瘤]