初诊多发性骨髓瘤患者发生3~4级MBD的风险预测模型构建  

Construction of a risk prediction model for grade 3-4 MBD in newly diagnosed multiple myeloma patients

作　　者：陈冰融 舒文秀[1] 罗柳飞 金钿 童嘉琦 乐静[1] CHEN Bingrong;SHU Wenxiu;LUO Liufei;JIN Dian;TONG Jiaqi;LE Jing(Department of Hematology,Ningbo Medical Center Lihuili Hospital,Ningbo 315040,Zhejiang,China)

机构地区：[1]宁波市医疗中心李惠利医院血液科,浙江宁波3150401

出　　处：《中国现代医生》2025年第1期22-25,33,共5页China Modern Doctor

摘　　要：目的探讨初诊多发性骨髓瘤(newly diagnosed multiple myeloma,NDMM)患者发生3~4级多发性骨髓瘤骨病(multiple myeloma bone disease,MBD)的影响因素,并建立列线图风险预测模型。方法回顾性选取2015年1月至2021年12月于宁波市医疗中心李惠利医院就诊的261例NDMM患者,根据初诊时MBD分级将其分为A组(MBD 0~2级,110例)和B组(MBD3~4级,151例),采用Logistic回归分析筛选NDMM患者发生3~4级MBD的危险因素并构建风险预测模型。使用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)进行综合评价。结果多因素回归分析结果显示,年龄、血清磷、C反应蛋白(C-reactive protein,CRP)、球蛋白(globulin,GLB)、骨髓浆细胞比例(bone marrow plasma cell percentage,BMPCp)均是NDMM患者发生3~4级MBD的独立危险因素(P<0.05)。基于此构建风险预测模型:logit(P)=–15.092+0.107(年龄)+1.150(血清磷)+0.057(CRP)+0.040(GLB)+0.212(BMPCp)。Hosmer-Lemeshow拟合优度检验预测概率与实际发生率之间没有显著差异(P=0.770)。该模型预测NDMM患者发生3~4级MBD的准确率为90.40%,曲线下面积为0.957(95%CI:0.932~0.981),预测能力较为可靠。结论年龄、血清磷、CRP、GLB、BMPCp均是NDMM患者发生3~4级MBD的独立危险因素,构建的风险预测模型对NDMM患者发生3~4级MBD的预测效果较好。Objective To investigate the influencing factors of grade 3–4 multiple myeloma bone disease(MBD)in newly diagnosed multiple myeloma(NDMM)patients,and establish a risk prediction model based on a nomogram.Methods A total of 261 patients with NDMM who were treated in Ningbo Medical Center Lihuili Hospital from January 2015 to December 2021 were retrospectively selected.The patients were divided into group A(MBD grade 0–2,110 cases)and group B(MBD grade 3–4,151 cases)according to MBD grade at the time of initial diagnosis.Logistic regression analysis was used to screen the risk factors for grade 3–4 MBD in NDMM patients,and the risk prediction model was constructed.The receiver operating characteristic(ROC)curve was used for comprehensive evaluation.Results Multivariate regression analysis showed that age,serum phosphorus,C-reactive protein(CRP),globulin(GLB)and bone marrow plasma cell percentage(BMPCp)were independent risk factors for grade 3–4 MBD in NDMM patients(P<0.05).Based on this,risk prediction model was constructed as follows:logit(P)=–15.092+0.107(age)+1.150(serum phosphorus)+0.057(CRP)+0.040(GLB)+0.212(BMPCp).There was no significant difference between the predicted probability and the actual incidence by the Hosmer-Lemeshow goodness of fit test(P=0.770).The accuracy of the model in predicting grade 3–4 MBD in NDMM patients was 90.40%,and the area under the curve was 0.957(95%CI:0.932–0.981),indicating a reliable prediction ability.Conclusion Age,serum phosphorus,CRP,GLB and BMPCp were all independent risk factors for grade 3–4 MBD in NDMM patients,and the constructed risk prediction model has a relatively good predictive effect on the occurrence of grade 3–4 MBD in NDMM patients.

关 键 词：多发性骨髓瘤 多发性骨髓瘤骨病 风险预测模型 

分 类 号：R733.3[医药卫生—肿瘤]