Study on predictive value of red blood cell distribution width/platelet count on prognosis of multiple myeloma
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摘要: 目的 研究红细胞分布宽度(RDW)/血小板计数(PLT)(RPR)对多发性骨髓瘤(MM)患者预后的预测价值。方法 查看电子病历，选取住院治疗的初诊MM患者68例，收集患者年龄、性别、血常规、生化、Durie-Salmon(DS)分期、修订的国际分期(RISS)结果，根据RPR对MM预后的最佳截断值将MM患者分为RPR高值组42例和RPR低值组26例，比较2组间临床资料差异，分析RPR对MM预后的影响。结果 RPR最佳截断值为0.12时预测价值最高，RPR高值组RDW、β2微球蛋白(β2-MG)、RISS Ⅲ期阳性率、乳酸脱氢酶(LDH)均高于RPR低值组，白蛋白/球蛋白(AGR)、血红蛋白(Hb)、PLT、白蛋白(ALB)均低于RPR低值组，差异均有统计学意义(P< 0.05)。RPR与AGR、ALB、Hb、PLT呈负相关，与RDW、β2-MG、LDH呈正相关(P< 0.05)。RPR高值组总生存期(OS)中位数为24个月，RPR低值组OS中位数为33个月，Kaplan-Meier生存分析显示两者间差异有统计学意义(χ2=4.186，P=0.041)，RPR高值组无进展生存期(PFS)中位数为21个月，RPR低值组PFS中位数为30个月，Kaplan-Meier生存分析显示两者间差异有统计学意义(χ2=4.642，P=0.031)。Cox生存分析显示，初诊Hb、RPR≥0.12、AGR≥1.20、β2-MG、RISS Ⅲ期均为OS的独立预后预测指标，RPR≥0.12、AGR≥1.20为PFS的独立预后预测指标(P< 0.05)。结论 RPR对MM的预后具有一定预测价值，且为MM患者OS、PFS的独立预后预测指标。Abstract: Objective To study the predictive value of red blood cell distribution width/platelet count(RPR) on the prognosis of multiple myeloma(MM).Methods Viewed the electronic medical records, selected 68 newly diagnosed MM patients who were hospitalized in our hospital, and collected the patient's age, gender, blood routine, biochemistry, DS staging, and RISS staging results. According to the best cutoff value of RPR on the prognosis of MM, they were divided into high RPR group and low RPR group. The differences in clinical data between the two groups were compared and the influence of RPR on the prognosis of MM was analyzed.Results The best RPR cutoff value was 0.12 when the predictive value was the highest. RDW, β2-MG, R-ISS phase Ⅲ positive rate and LDH in the high RPR group were all higher than those in the low RPR group, and AGR, Hb, PLT and ALB were lower than those in the low RPR group, the differences were statistically significant(allP< 0.05). RPR was negatively correlated with AGR, ALB, Hb and PLT, and positively correlated with RDW, β2-MG and LDH(allP< 0.05). The median overall survival(OS) in the high RPR group and the low RPR group was 24 months and 33 months, respectively. Kaplan-Meier survival analysis showed that the difference between the two was statistically significant(χ2=4.186,P=0.041), The median progression-free survival(PFS) in the high RPR group and the low RPR group was 21 months and 30 months, respectively. Kaplan-Meier survival analysis showed that the difference between the two was statistically significant(χ2=4.642,P=0.031). Cox survival analysis showed that newly diagnosed Hb, RPR≥0.12, A/G≥1.20, β2-MG and R-ISS stage Ⅲ were independent prognostic predictive indicators of OS, and RPR≥0.12 and A/G≥1.20 were independent prognosis predictive indicators of PFS(allP< 0.05).Conclusion RPR may have a certain predictive value for the prognosis of MM, and can be an independent prognostic predictive indicator of OS and PFS in MM patients.
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表 1 不同RPR患者临床资料的比较
X±S 临床资料 RPR高值组(42例) RPR低值组(26例) t(χ2) P AGR 1.11±0.21 1.34±0.36 3.333 0.001 Hb/(g·L-1) 86.22±14.32 97.21±16.30 2.916 0.005 RDW/% 14.51±1.30 13.76±1.25 2.345 0.022 PLT/(×109·L-1) 106.72±33.66 148.55±46.57 4.292 < 0.001 RPR 0.14±0.06 0.10±0.09 2.20 0.031 ALB/(g·L-1) 30.56±11.84 41.33±10.21 3.836 < 0.001 β2-MG/(mg·L-1) 5.95±1.02 5.06±1.14 3.342 0.001 BUN/(mmol·L-1) 7.51±1.59 7.04±1.33 1.258 0.213 Cr/(μmol·L-1) 107.32±12.43 102.61±15.85 1.365 0.177 DS分期/例(%) Ⅰ期 6(14.29) 4(15.38) 1.596 0.450 Ⅱ期 12(28.57) 11(42.31) Ⅲ期 24(57.14) 11(42.31) RISS分期/例(%) Ⅰ期 5(11.90) 5(19.23) 6.315 0.043 Ⅱ期 8(19.05) 11(42.31) Ⅲ期 29(69.05) 10(38.46) Ca/(mmol·L-1) 2.96±0.41 2.78±0.39 1.792 0.077 LDH/(IU·L-1) 262.75±25.35 201.33±31.26 8.874 0.000 死亡/例(%) 23(54.76) 10(38.46) 1.708 0.191 
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表 2 Cox回归模型对OS、PFS预后因素的单变量和多变量分析
影响因素 OS PFS 单因素分析
HR(95%CI)P 多因素分析
HR(95%CI)P 单因素分析
HR(95%CI)P 多因素分析
HR(95%CI)P 年龄 1.04(0.82~ 1.96) 0.624 1.01(0.99~ 1.23) 0.731 男性 0.96(0.73~ 1.86) 0.793 0.99(0.68~ 1.76) 0.852 Hb 0.52(0.36~ 0.85) 0.007 0.59(0.42~ 0.91) 0.019 0.89(0.68~ 1.14) 0.496 RPR≥0.12 2.96(1.45~ 3.88) 0.002 2.54(1.62~ 3.73) 0.010 1.98(1.34~ 3.54) 0.024 1.87(1.36~ 3.47) 0.030 AGR≥1.20 0.65(0.38~ 0.96) 0.032 0.72(0.45~ 0.98) 0.042 0.69(0.34~ 0.87) 0.028 0.71(0.36~ 0.85) 0.034 β2-MG 1.83(1.14~ 4.21) 0.025 1.79(1.22~ 3.56) 0.028 1.21(0.93~ 2.54) 0.245 BUN/ 1.27(0.86~ 1.95) 0.175 1.13(0.74~ 2.51) 0.336 Cr 1.12(0.73~ 1.88) 0.201 1.16(0.82~ 2.63) 0.298 DS分期 Ⅰ期 1 1 Ⅱ期 1.25(0.98~ 2.02) 0.196 1.19(0.76~ 1.94) 0.197 Ⅲ期 1.36(1.02~ 2.83) 0.137 1.34(0.94~ 3.51) 0.262 RISS分期 Ⅰ期 1 1 Ⅱ期 1.19(0.78~ 2.42) 0.205 1.42(1.14~ 3.96) 0.102 Ⅲ期 1.98(1.14~ 3.52) 0.017 1.82(1.34~ 3.46) 0.029 1.58(1.27~ 4.02) 0.045 1.49(1.31~ 3.98) 0.058 Ca≥2.80 mmol/L 1.37(0.96~ 3.02) 0.129 1.13(0.83~ 2.92) 0.342 LDH 1.41(0.83~ 3.19) 0.082 1.12(0.79~ 3.72) 0.404
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