初诊多发性骨髓瘤合并贫血患者临床特征及贫血发生因素分析  

Clinical features and factors for the occurrence of anemia in newly-diagnosed multiple myeloma patients with anemia

作　　者：樊双增 陆璐 付运秋 杨雪 方美云 Fan Shuangzeng;Lu Lu;Fu Yunqiu;Yang Xue;Fang Meiyun(Department of Hematology,the People's Hospital of Qiannan in Guizhou Province,Duyun 558000,China;Department of Hematology,Affiliated Zhongshan Hospital of Dalian University,Dalian 116000,China)

机构地区：[1]贵州省黔南州人民医院血液科,都匀558000 [2]大连大学附属中山医院血液科,大连116000

出　　处：《白血病．淋巴瘤》2024年第5期277-282,共6页Journal of Leukemia & Lymphoma

摘　　要：目的探讨初诊多发性骨髓瘤(NDMM)合并贫血患者的临床特征、疗效及贫血发生的危险因素。方法回顾性病例对照研究。回顾性分析2018年1月至2022年12月于贵州省黔南州人民医院和大连大学附属中山医院住院的165例NDMM患者的一般资料及实验室检查结果。患者均接受至少包括蛋白酶体抑制剂和免疫调节剂两种新药为基础的化疗方案治疗,治疗4个周期后评估疗效。按照外周血血红蛋白(Hb)浓度,将患者分为贫血组(Hb<100 g/L)和非贫血组(Hb≥100 g/L)。比较两组患者一般资料、血液学指标以及治疗效果。采用Pearson相关系数分析Hb与血液学指标的相关性;采用多因素logistic回归分析NDMM患者发生贫血的危险因素;以Hb定义的贫血为金标准,采用受试者工作特征(ROC)曲线分析依据上述贫血发生危险因素判断MM患者贫血发生的效果。结果贫血组120例,中位年龄[M(Q_(1),Q_(3))]64岁(59岁,74岁),男性61例(50.8%),女性59例(49.2%);非贫血组45例,中位年龄61岁(54岁,68岁),男性27例(60.0%),女性18例(40.0%)。贫血组患者年龄及Durie-Salmon(DS)分期Ⅲ期、国际分期系统(ISS)分期Ⅲ期、肾功能损害、高钙血症患者比例均高于非贫血组(均P<0.05);贫血组外周血血小板计数、血清清蛋白浓度均低于非贫血组,差异均有统计学意义(均P<0.05),球蛋白浓度、红细胞沉降率(ESR)、血清β_(2)-微球蛋白(β_(2)-MG)浓度、肌酐浓度、尿酸浓度、血清校正钙浓度、骨髓异常浆细胞比例均高于非贫血组,差异均有统计学意义(均P<0.05)。贫血组客观缓解率低于非贫血组[42.5%(51/120)比71.1%(32/45),χ^(2)=10.72,P=0.001]。Pearson相关系数显示,Hb浓度与血清清蛋白浓度和血小板计数均呈正相关(r值分别为0.569和0.229,均P<0.05),与ESR、球蛋白、β_(2)-MG、肌酐、尿酸、血清校正钙浓度及骨髓异常浆细胞比例均呈负相关(r值分别为-0.318、-0.465、-0.373、-0.230、-0.303�Objective To investigate the clinical features,efficacy and risk factors for the development of anemia in newly-diagnosed multiple myeloma(NDMM)patients with anemia.Methods A retrospective case-control study was conducted.General data and laboratory findings of 165 NDMM patients hospitalized at the People's Hospital of Qiannan in Guizhou Province and Affiliated Zhongshan Hospital of Dalian University from January 2018 to December 2022 were retrospectively analyzed.The patients were treated with chemotherapy regimens based on at least 2 new drugs including proteasome inhibitors and immunomodulators,and the efficacy was assessed after 4 cycles of treatment.According to peripheral blood hemoglobin(Hb)concentration,patients were divided into anemia group(Hb<100 g/L)and non-anemia group(Hb≥100 g/L).The general data,hematological indexes,and treatment effects of the two groups were compared.Pearson correlation coefficient was used to analyze the correlation between Hb and hematological indexes;multivariate logistic regression was used to analyze the risk factors for the occurrence of anemia in patients with NDMM;anemia defined by Hb was used as the gold standard,and receiver operating characteristic(ROC)curve was used to analyze the effect of the above risk factors for anemia on judging the occurrence of anemia in MM patients.Results There were 120 cases in the anemia group with a median age[M(Q_(1),Q_(3))]of 64 years old(59 years old,74 years old),including 61(50.8%)males and 59(49.2%)females,and 45 cases in the non-anemia group with a median age of 61 years old(54 years old,68 years old),including 27(60.0%)males and 18(40.0%)females.The age of patients and the proportion of patients with Durie-Salmon(DS)stage Ⅲ,international staging system(ISS)stage Ⅲ,renal impairment,and hypercalcemia in the anemia group were higher than those in the non-anemia group(all P<0.05);peripheral blood platelet counts and serum albumin concentrations in the anemia group were lower than those in the non-anemia group,and the difference

关 键 词：多发性骨髓瘤 贫血 治疗结果 白蛋白类 浆细胞 

分 类 号：R733.3[医药卫生—肿瘤] R556[医药卫生—临床医学]