不同血液分离结果的多发性骨髓瘤骨病患者骨代谢水平研究  

Bone Metabolism of Multiple Myeloma Bone Disease Patients with Different Blood Separation Results

作　　者：范泽文 褚娜利 闫石 乔建启 于巧亚 张靖宇[1] FAN Ze-Wen;CHU Na-Li;YAN Shi;QIAO Jian-Qi;YU Qiao-Ya;ZHANG Jing-Yu(Department of Laboratory Diagnosis,Cangzhou Hospital of Integrated TCM-WM-Hebei,Cangzhou 061000,Hebei Province,China;The Fourth Department of Orthopedics,Cangzhou People′s Hospital,Cangzhou 061000,Hebei Province,China)

机构地区：[1]河北省沧州中西医结合医院实验诊断科,河北沧州061000 [2]沧州市人民医院骨四科,河北沧州061000

出　　处：《中国实验血液学杂志》2024年第3期799-804,共6页Journal of Experimental Hematology

基　　金：沧州市科学技术研究与发展指导计划项目(213106073);河北省卫健委重点科技研究计划(20191283)。

摘　　要：目的:探讨不同血液分离结果的骨髓瘤骨病(MBD)患者骨代谢指标对病情评估及疗效监测的临床意义。方法:纳入2016年3月至2020年3月河北省沧州中西医结合医院收治的134例初诊MM患者,根据血液离心结果,分为对照组119例(样本自上而下依次为血清、胶体、红细胞),异常组15例(样本自上而下依次为血清、红细胞、胶体、红细胞),根据影像学表现将MBD分为0-4级,0-2级为骨病较轻者,3-4级为骨病较重者,分析两组患者MBD的分级情况,并对不同血液分离结果的MBD患者进行疗效评价,分析治疗前后血液分离结果及骨代谢指标水平的变化,采用Pearson相关分析法分析β2-微球蛋白(MG)与骨代谢指标水平的相关性。结果:对照组0-2级69例,3-4级50例;异常组0-2级5例,3-4级10例,比较差异具有统计学意义(P<0.05)。异常组血清β2-MG、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)水平显著高于对照组,而Ⅰ型前胶原氨基端前肽(P1NP)、骨钙素(OC)水平显著低于对照组(均P<0.001)。对照组95例疗效≥部分缓解(PR),其血液分离结果未改变;24例疗效<PR,其中5例血液分离结果转为异常。异常组9例疗效≥PR,血液分离结果均转为正常;6例疗效<PR,其中5例血液分离结果仍为异常。与治疗前相比,对照组疗效≥PR的患者β-CTX、β2-MG水平显著降低,而P1NP、OC水平显著升高(均P<0.001);异常组疗效≥PR的患者β-CTX、β2-MG水平亦显著降低(P<0.001,P<0.01),而P1NP、OC水平显著升高(P<0.001,P<0.01)。两组疗效<PR的患者各指标水平与治疗前相比无明显变化(P>0.05)。与疗前相比,对照组治疗后血液分离结果未改变的患者β-CTX、β2-MG水平显著降低(均P<0.001),P1NP、OC水平显著升高(P<0.01,P<0.001),而血液分离结果转为异常的患者各指标水平无明显变化(P>0.05);异常组治疗后血液分离结果转为正常的患者β-CTX、β2-MG水平显著降低(均P<0.01),P1NP、OC水平显著升高(P<0.001,P<0.Objective:To investigate the clinical significance of bone metabolic indexes for disease assessment and curative effect monitoring in multiple myeloma(MM)bone disease(MBD)patients with different blood separation results.Methods:A total of 134 newly diagnosed MM patients treated in Cangzhou Hospital of Integrated TCM-WMHebei were enrolled and divided into control group[119 cases,serum,colloid and red blood cell(RBC)from top to bottom of sample]and abnormal group(15 cases,serum,mixed layer of RBC and serum,colloid and RBC from top to bottom of sample)according to the results of blood separation.According to the imaging findings,MBD was classified into grade 0-4,grade 0-2 was mild,and grade 3-4 was severe.The MBD grade of patients in the two groups was analyzed.The curative effect of MBD patients after chemotherapy and the changes of blood separation results and bone metabolic indexes before and after treatment were evaluated.The correlation betweenβ2-microglobulin(MG)and bone metabolic indexes was analyzed by Pearson correlation analysis.Results:In the control group,there were 69 cases of grade 0-2 and 50 cases of grade 3-4,while in the abnormal group,there were 5 cases of grade 0-2 and 10 cases of grade 3-4,the difference was statistically significant(P<0.05).The serumβ2-MG,β-CTX levels in abnormal group were both significantly higher than those in control group,while the levels of P1NP and osteocalcin(OC)were significantly lower(all P<0.001).In the control group,there were 95 patients with≥partial response(PR)and the blood separation results were not changed,while 24 patients with<PR and 5 of them had abnormal blood separation results.In the abnormal group,9 patients with efficacy≥PR showed normal blood separation results,while 6 patients with efficacy<PR and 5 of them still remained abnormal blood separation results.Compared with before treatment,β-CTX andβ2-MG of patients with efficacy≥PR were significantly decreased but P1NP and OC increased in the control group(all P<0.001),which was the same as ab

关 键 词：多发性骨髓瘤 血液分离 骨代谢指标 临床意义 

分 类 号：R733.3[医药卫生—肿瘤]