Study on predictive value of blood routine index in clinical staging and prognosis of newly diagnosed multiple myeloma
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摘要: 目的：研究血常规检测指标对多发性骨髓瘤（MM）临床分期和预后预测价值。方法：选取初诊MM患者94例，根据修订的国际分期系统（R-ISS）、Durie-Salmon （DS）分期系统将MM患者进行临床分期，并收集患者血常规结果，计算中性粒细胞/淋巴细胞比值（NLR）、单核细胞/淋巴细胞比值（MLR）、血小板/淋巴细胞比值（PLR），分析2种分期方法结果差异，比较不同临床分期血常规指标差异以及血常规指标与临床分期相关性，单因素和COX回归分析血常规指标对MM预后的影响。结果：DS分期与R-ISS分期一致性Kappa值为0.393（P<0.05），不同分期方法各组血红蛋白（Hb）两两比较差异均有统计学意义（均P<0.05）。DSⅠ组NLR、红细胞分布宽度（RDW）均小于DSⅢ组，DSⅡ组PLR、血小板平均体积（MPV）均高于DSⅢ组；R-ISSⅠ组NLR、PLR、MPV、RDW均低于R-ISSⅢ组，R-ISSⅠ组RDW均低于R-ISSⅡ组，差异均有统计学意义（均P<0.05）。DS分期与Hb呈负相关（r=-0.421），与RDW、NLR呈正相关（r=0.221~0.251）；R-ISS分期与Hb呈负相关（r=-0.379），R-ISS分期与NLR、PLR、MPV、RDW呈正相关（r=0.225~0.317），均P<0.05。Hb、NLR、RDW均为影响MM患者预后的影响因素，OR值分别为0.473、2.153、1.888（均P<0.05），Kaplan-Meier生存曲线分析显示，高NRL、低NRL，高Hb、低Hb，高RDW、低RDW患者总生存期差异均有统计学意义（P<0.05）。结论：血常规中多种指标与MM患者临床分期密切相关，初诊MM患者低Hb、高NLR、RDW可提示预后不良。Abstract: Objective: To study the predictive value of blood routine test indexes for clinical staging and prognosis of multiple myeloma(MM).Methods: A total of 94 newly diagnosed MM patients in our hospital were selected. According to the revised International Staging system(R-ISS) and Durie-Salmon(DS) staging system, MM patients were clinically staged, and blood routine results were collected. Neutrophils/lymphocytes ratio(NLR), monocytes/lymphocytes ratio(MLR) and platelets/lymphocytes ratio(PLR) were calculated, the results of the two staging methods, the differences in blood routine indexes and correlation of blood routine indexes with clinical stage, single factor were compared, and effect of blood routine indicators on the prognosis of MM was detected by COX regression analysis.Results: The Kappa value of consistency between DS staging and R-ISS staging was 0.393(P<0.05). There were statistically significant differences in Hb between different stages. NLR and RDW in DS I group were lower than those in DS Ⅲ group, PLR and MPV in DS Ⅱ group were higher than those in DS Ⅲ group, NLR, PLR, MPV and RDW in R-ISS I group were lower than those in R-ISS Ⅲ group, RDW in R-ISS I group were lower than those in R-ISS Ⅱ group, the differences were statistically significant(all P<0.05). DS stage was negatively correlated with Hb(r=-0.421), positively correlated with RDW and NLR(r=0.221-0.251), R-ISS stage was negatively correlated with Hb(r=-0.379), positively correlated with NLR, PLR, MPV and RDW(r=0.225-0.317), all P<0.05. Hb, NLR and RDW were the influencing factors for the prognosis of MM patients, and the OR values were 0.473, 2.153 and 1.888(all P<0.05). Kaplan-Meier survival curve analysis showed that there were significant differences in overall survival of patients with high NRL, low NRL, high Hb, low Hb, high RDW and low RDW.Conclusion: A variety of indicators in blood routine were closely related to clinical staging. Low Hb, high NLR and RDW in newly diagnosed MM patients might indicate poor prognosis.
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