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摘要: 目的 探索血管内皮生长因子(VEGF)水平在多发性骨髓瘤患者(MM)中的意义。方法 选取2018年6月至2020年12月初诊于甘肃省人民医院血液内科MM患者59例，检测其VEGF、白蛋白(ALB)、乳酸脱氢酶(LDH)及β2-微球蛋白(β2-MG)等实验室指标，分析VEGF与MM患者各临床指标相关性；单因素和多因素分析各实验室指标对MM患者预后的影响；通过生存分析初步评估VEGF等水平对MM预后价值。结果 VEGF升高的MM患者血小板及ALB水平减低，而β2-MG、LDH及血肌酐(Cr)水平则明显升高(P< 0.05)；分期较晚的患者VEGF水平更高(P< 0.05)；单因素及多因素分析显示VEGF、β2-MG、ALB及Cr可影响MM患者预后；生存分析显示VEGF、β2-MG和不良预后有关。结论 VEGF水平与MM患者各临床指标存在相关性，并对预后有重要意义。Abstract: Objective To explore the significance of VEGF level in patients with multiple myeloma(MM).Methods A total of 59 patients with newly diagnosed MM in Gansu Provincial Hospital from June 2018 to December 2020 were selected. Vascular endothelial growth factor(VEGF), albumin(ALB), lactate dehydrogenase(LDH), β2-microglobulin(β2-MG), and other laboratory indexes were examined. The clinical correlation between VEGF and characteristics of patients with MM was analyzed. The effect of each clinical index on the prognosis of these patients was analyzed via univariate and multivariate analyses. The prognostic value of VEGF and other levels in MM was evaluated by survival analysis.Results In MM patients with elevated VEGF, platelet and ALB levels were decreased, but β2-MG, LDH and serum creatinine(Cr) levels were significantly increased(P< 0.05). VEGF level was higher in patients with later stage(P< 0.05). Univariate and multivariate analyses showed that VEGF, β2-MG, ALB and CR affected the prognosis of patients with MM, and survival analysis showed that VEGF and β2-MG were associated with poor prognosis.Conclusion VEGF level might be correlated with the clinical indicators of MM patients, and be of great significance for the prognosis.
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Key words:
- multiple myeloma /
- vascular endothelial growth factor /
- follow-up outcome
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表 1 MM患者VEGF水平与各临床指标间关系
X±S 相关指标 < 142.2 pg/mL组 ≥142.2 pg/mL组 t P 血红蛋白/(g·L-1) 100.66±24.45 97.81±29.17 0.407 0.685 血小板计数/(×109·L-1) 177.47±82.35 133.30±56.23 2.360 0.022 β2-MG/(mg·L-1) 3.77±1.97 7.88±3.36 -5.837 <0.001 ALB/(g·L-1) 34.15±6.85 30.63±5.56 2.139 0.037 LDH/(U·L-1) 156.81±46.84 207.30±71.66 -3.249 0.002 血糖/(mmol·L-1) 6.16±1.64 5.41±1.94 1.607 0.114 血钙/(mmol·L-1) 2.22±0.36 2.27±0.33 -0.535 0.595 浆细胞比例/% 26.03±15.94 25.52±19.18 0.111 0.912 年龄/岁 59.06±9.41 59.22±9.28 -0.065 0.948 Cr/(μmol·L-1) 100.90±30.53 182.13±136.37 -3.278 0.002 
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表 2 不同VEGF水平与疾病分期及性别的相关性分析
例 变量 组别 < 142.2
pg/mL组≥142.2
pg/mL组χ2 P 随访结果 存活 0 9 12.587 < 0.001 死亡 32 18 分期 Ⅰ 9 2 0.546 0.014 Ⅱ 10 4 Ⅲ 13 21 性别 男 21 16 0.254 0.614 女 11 11
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表 3 各临床指标与MM患者预后的相关性分析
X±S 变量 存活组 死亡组 t P 血红蛋白/(g·L-1) 100.44±27.84 93.33±17.34 0.737 0.464 血小板计数/(×109·L-1) 160.60±75.72 138.66±867.41 0.812 0.420 β2-MG/(mg·L-1) 5.05±2.84 8.99±4.29 -3.525 0.001 ALB/(g·L-1) 33.38±6.46 27.87±4.47 2.449 0.017 LDH/(U·L-1) 175.88±63.46 202.33±67.26 -1.141 0.258 血糖/(mmol·L-1) 5.82±1.45 5.80±3.29 0.027 0.979 血钙/(mmol·L-1) 2.21±0.31 2.42±0.48 -1.718 0.091 浆细胞比例/% 26.44±18.01 22.19±13.28 0.674 0.503 年龄/岁 58.20±8.95 64.33±9.81 -1.866 0.067 Cr/(μmol·L-1) 124.24±90.31 214.92±135.40 -2.558 0.013 VEGF水平/(pg·mL-1) 141.79±150.15 341.67±106.15 -3.812 < 0.001
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表 4 单因素分析疾病分期及年龄与MM患者预后
例 因素 分组 存活组 死亡组 χ2 P 分期 Ⅰ 11 0 2.738 0.254 Ⅱ 12 2 Ⅲ 27 7 性别 男 33 4 1.516 0.218 女 17 5
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表 5 多因素分析各指标与MM患者预后
因素 β SE Wald P Exp(β) 95%CI β2-MG 0.724 0.346 4.366 0.037 2.062 1.046~4.065 ALB -0.558 0.279 4.014 0.045 0.572 0.331~0.988 Cr 0.003 0.005 0.368 0.544 1.003 0.993~1.013 VEGF水平 0.015 0.006 5.677 0.017 1.015 1.003~1.028 常数 4.032 4.911 0.674 0.412 56.364
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表 6 Cox回归分析各指标与MM患者预后
因素 β SE Wald P Exp(β) 95%CI VEGF水平 0.009 0.004 5.480 0.019 1.009 1.001~1.016 β2-MG 0.224 0.105 4.519 0.034 1.251 1.018~1.538 ALB -0.087 0.090 0.927 0.336 0.917 0.768~1.094
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