影响多发性骨髓瘤BCD方案疗效的因素及与骨代谢、中性粒细胞/淋巴细胞比值、白细胞介素6、纤维蛋白原的相关性  

Factors affecting the efficacy of BCD scheme in multiple myeloma and its correlation with bone metabolism,neutrophil/lymphocyte ratio,interleukin-6,and fibrinogen

作　　者：尹盼盼 褚娜利 孟雅楠 闫石 范泽文 乔建启 白海龙 YIN Pan-pan;CHU Na-li;MENG Ya-nan;YAN Shi;FAN Ze-wen;QIAO Jian-qi;BAI Hai-long(Department of Laboratory Diagnostics,Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou 061000,Hebei,China;Department of Radiotherapy and Chemotherapy,Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou 061000,Hebei,China;Department of Orthopedics,Cangzhou People's Hospital,Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou 061000,Hebei,China;Department of Blood Transfusion,Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou 061000,Hebei,China;Department of Diabetes Endocrinology,Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou 061000,Hebei,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]河北省沧州中西医结合医院,放化疗科,河北沧州061000 [3]沧州市人民医院骨科,河北沧州061000 [4]沧州市人民医院输血科,河北沧州061000 [5]沧州市人民医院糖尿病内分泌科,河北沧州061000

出　　处：《川北医学院学报》2024年第12期1640-1644,共5页Journal of North Sichuan Medical College

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

摘　　要：目的:分析影响多发性骨髓瘤(MM)患者BCD(硼替佐米、环磷酰胺、地塞米松)方案疗效的因素及与骨代谢、中性粒细胞(NEU)/淋巴细胞(LYM)比值(NLR)、白细胞介素6(IL-6)、纤维蛋白原(FiB)水平的相关性。方法:选取120例MM患者作为研究对象,采用BCD方案治疗,根据疗效分为有效组(n=88)和难治无效组(n=32),比较两组患者一般资料、Durie-Salmon(DS)分期及实验室检查相关指标,将有差异指标纳入Logistic回归分析;采用Spearman分析BCD疗效与骨代谢标志物、NLR、IL-6、FiB相关性,并绘制受试者工作特征曲线(ROC)。结果:BCD方案有效率为73.33%。有效组DS分期、国际分期系统(ISS)分期小于难治无效组(P<0.05)。有效组1型胶原氨基末端延长肽(P1NP)、血清骨钙素(OCN-MID)高于难治无效组,1型胶原羧基末端延长肽(β-CTX)、FiB、IL-6、NLR均低于难治无效组(P<0.05)。Logistic回归分析显示,P1NP、OCN-MID、β-CTX、FiB、IL-6、NLR及ISS分期Ⅲ期是影响MM患者BCD方案疗效危险因素(P<0.05)。β-CTX、FiB、IL-6、NLR与MM患者BCD方案疗效负相关(r=-0.306、-0.538、-0.504、-0.493,P<0.05);P1NP、OCN-MID与MM患者BCD方案疗效正相关(r=0.329、0.451,P<0.05)。β-CTX>0.79μg/L、FiB>4.38 g/L、IL-6>141.69 pg/mL、NLR>2.02预测MM患者BCD方案疗效有中等预测价值。结论:骨代谢标志物、NLR、IL-6、FiB、DS、ISS分期是影响MM患者BCD方案疗效的危险因素,且骨代谢标志物、NLR、IL-6、FiB与疗效相关,β-CTX、NLR、IL-6、FiB可作为预测MM患者BCD方案疗效的辅助指标。Objective:To analyze the factors affecting the efficacy of BCD(Bortezomib,cyclophosphamide,dexamethasone)regimen in patients with multiple myeloma(MM)and the correlation with bone metabolism,neutrophil/lymphocyte ratio(NLR),interleukin-6(IL-6),fibrinogen(FiB)levels.Methods:120 MM patients were treated with the BCD regimen and were divided into an effective group(n=88)and a refractory ineffective group(n=32)according to efficacy.The basic data,Durie-Salmon(DS)staging,and laboratory-related indicators of the two groups of patients were compared,and the different indicators were included in the Logistic regression.Spearman analysis was used to analyze the correlation between the efficacy of BCD and bone metabolism markers,NLR,IL-6 and FiB,and the receiver operating characteristic curve(ROC)was drawn.Results:The effective rate of BCD regimen was 73.33%.The DS stage and International Staging System(ISS)stage of the effective group were lower than those of the refractory ineffective group(P<0.05).In the effective group,type I collagen amino-terminal extension peptide(P1NP)and serum osteocalcin(OCN-MID)were higher than those in the refractory ineffective group,while type I collagen carboxy-terminal extension peptide(β-CTX),FiB,IL-6,and NLR were lower than those in the refractory ineffective group(P<0.05).Logistic regression analysis showed that P1NP,OCN-MID,β-CTX,FiB,IL-6,NLR,and ISS stage III were risk factors affecting the efficacy of the BCD regimen in patients with MM(P<0.05).β-CTX,FiB,IL-6,and NLR were negatively correlated with the efficacy of the BCD regimen in MM patients(r=-0.306,-0.538,-0.504,-0.493,P<0.05),P1NP and OCN-MID were positively correlated with the efficacy of the BCD regimen in MM patients(r=0.329,0.451,P<0.05).β-CTX>0.79μg/L,FiB>4.38 g/L,IL-6>141.69 pg/ml,and NLR>2.02 had moderate predictive value for predicting the efficacy of the BCD regimen in MM patients.Conclusion:Bone metabolism markers,NLR,IL-6,FiB,DS,and ISS staging are risk factors affecting the efficacy of BCD regimen in MM patients

关 键 词：多发性骨髓瘤 BCD方案 影响因素 骨代谢 NLR IL-6 FIB 

分 类 号：R733.3[医药卫生—肿瘤]