控制营养状态评分对新诊断多发性骨髓瘤患者预后的预测价值  

Predictive value of controlling nutritional status score for prognosis in patients with newly diagnosed multiple myeloma

作　　者：孙倩倩 陶洁[1] Sun Qianqian;Tao Jie(Department of Hematology,First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第一医院血液科,太原030001

出　　处：《国际输血及血液学杂志》2024年第2期147-156,共10页International Journal of Blood Transfusion and Hematology

摘　　要：目的探讨控制营养状态(CONUT)评分对新诊断多发性骨髓瘤(MM)患者预后的预测价值。方法选择2017年1月至2021年12月于山西医科大学第一医院血液科住院治疗的82例MM患者为研究对象。其中男性患者为48例,女性为34例,中位年龄为66.5岁(58.0,73.0岁)。回顾性分析患者的临床资料,根据患者化疗前血清白蛋白(ALB)值、总胆固醇(TC)水平、淋巴细胞绝对计数(ALC)计算CONUT评分,并绘制CONUT评分预测MM患者生存结局的受试者工作特征(ROC)曲线,根据ROC-曲线下面积(AUC)和约登指数最大原则,确定CONUT评分最佳临界值,并根据该临界值将患者分为高、低CONUT评分组。组间定性资料比较采用χ^(2)检验,组间定量资料比较采用Mann-Whitney U检验。采用Kaplan-Meier法绘制MM患者的总体生存(OS)曲线,采用log-rank检验比较不同临床特征MM患者的OS率。采用Cox比例风险回归模型对影响患者OS率的因素进行单因素及多因素分析。本研究遵循的程序符合2013年修订版《世界医学协会赫尔辛基宣言》要求,并且与所有受试者签署临床研究知情同意书。结果①通过ROC曲线确定CONUT评分预测MM患者生存结局的最佳临界值为3.5分,ROC-AUC为0.668(95%CI:0.546~0.791),此时预测敏感度为86.4%,特异度为50.0%。②根据最佳临界值,将82例患者分为高CONUT评分(n=57,CONUT评分≥3.5分)和低CONUT评分组(n=23,CONUT评分<3.5分)。高CONUT评分组患者的年龄、β2-微球蛋白(MG)、球蛋白值较低CONUT评分组患者升高(Z=-2.68、P=0.007,Z=-2.13、P=0.019,Z=-3.51、P<0.001),血红蛋白(Hb)值、ALC、ALB值、TC水平较低CONUT评分组患者降低(Z=-3.15、P=0.002,Z=-2.61、P=0.008,Z=-5.64、P<0.001,Z=-5.18、P<0.001),并且差异均有统计学意义。③CONUT评分≥3.5分患者3年OS率为10.5%,较CONUT评分<3.5分者的32.0%降低,并且差异有统计学意义(χ^(2)=15.36,P<0.001)。④单因素及多因素分析结果显示,CONUT评分≥3.5分是影�Objective To investigate the predictive value of the nutritional control status(CONUT)score in evaluating the prognosis of patients with first-diagnosed multiple myeloma(MM).Methods From January 2017 to December 2021,a total of 82 cases of MM patients who were hospitalized in the Department of Hematology of First Hospital of Shanxi Medical University were included as the study subjects.Among them,48 cases were male patients and 34 cases were female.The clinical data of these patients were retrospectively analyzed,the CONUT scores were calculated based on the patients′pre-chemotherapy serum albumin(ALB)value,total cholesterol(TC)level,and absolute lymphocyte counts(ALC).Receiver operator characteristic(ROC)curves of CONUT scores for predicting the survival outcome of MM patients were plotted.Based on the principle of ROC-area under the curve(AUC)and the maximum Youden index,the best cut-off value of CONUT score were determined,and patients were classified into high and low CONUT score groups according to that value.The chi-square test was used to compare qualitative data between groups,and the Mann-Whitney U test was used to compare quantitative data between groups.The Kaplan-Meier method was used to draw the overall survival(OS)curves of MM patients,and the log-rank test was used to compare the OS rates among different types of patients.Univariate and multivariate analysis of factors influencing OS rate of patients were performed by Cox proportional hazards regression model.This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from the subjects.Results①The best cut-off value of CONUT score for predicting the survival cutcomes of MM patients was determined to be 3.5 points by ROC curve,and the ROC-AUC was 0.668(95%CI:0.546-0.791).At this point,the sensitivity of prediction was 86.4%and the specificity was 50.0%.②Based on the best cut-off value,these 82 MM patients were divided into high CONUT score(n=57,CONUT score≥3.5 points)and l

关 键 词：多发性骨髓瘤 营养不良 预后 危险因素 控制营养状态评分 

分 类 号：R733.3[医药卫生—肿瘤]