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摘要: 目的 探讨补体C4对新诊断多发性骨髓瘤(MM)患者生存预后的价值。方法 回顾性分析2015年1月—2020年6月在江苏省苏北人民医院确诊的111例MM患者的临床资料，通过Cox回归分析对其生存预后进行单因素及多因素分析，通过logistic回归分析对2年生存期进行单因素及多因素分析。结果 111例MM患者中男59例，女52例，中位年龄64(34~86)岁，总体中位生存期为51个月。通过Cox回归分析进行生存预后分析，结果显示补体C4水平及年龄为影响预后的独立因素(P < 0.05)。通过logistic回归分析对2年生存期进行分析，结果显示补体C4≥0.2 mg/mL、年龄≥70岁及白细胞计数≤4.4×109/L为独立预后因素，同时存在3个危险因素的患者2年内死亡的风险是存在0~2个危险因素患者的8倍(P < 0.05)。结论 高补体C4水平的患者生存预后差，补体C4水平可以作为MM患者生存预后的潜在生物学标记物。Abstract: Objective To explore the predictive value of completement C4 in newly diagnosed multiple myeloma(MM).Methods The clinical data of 111 newly diagnosed MM were retrospectively analyzed. The univariate and multivariate analysis for overall survival(OS) were made through Cox regression analysis and univariate and multivariate analysis for two-year survival were made through logistic regression analysis.Results Among the 111 patients, there were 59 males and 52 females, with a medium age of 64(34-86) years and the medium OS was 51 months. It revealed that high C4 level and advanced age were the independent factors of OS through Cox regression analysis(P < 0.05). C4≥0.2 mg/mL, age≥70 years and WBC≤4.4×109/L were independent factors for two-year survival through logistic regression analysis(P < 0.05). It indicated that patients with 3 risk factors had 8 folds of mortality risk in two years than patients with 0-2 risk factors(P < 0.05).Conclusion Patients with high level C4 have poor OS and C4 can be the potential biomarker for OS of newly diagnosed MM.
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Key words:
- multiple myeloma /
- completement C4 /
- survival analysis
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表 1 111例患者的临床资料及影响OS的单因素及多因素分析
临床特征 总例数(n=111) HR 95%CI P 单因素分析 性别/例(%) 0.810 0.484~1.354 0.421 男 59(53.15) 女 52(46.85) 年龄/岁 62.66±9.68 1.045 1.016~1.075 0.002 血红蛋白/(g·L-1) 86.11±25.42 1.001 0.991~1.011 0.800 白细胞计数/(×109·L-1) 5.04±2.08 0.814 0.693~0.956 0.007 中性粒细胞/(×109·L-1) 3.70±4.75 1.017 0.960~1.078 0.560 淋巴细胞/(×109·L-1) 1.34±0.66 0.519 0.304~0.886 0.016 血小板计数/(×109·L-1) 160.23±74.92 0.997 0.993~1.001 0.139 白蛋白/(g·L-1) 36.01±7.00 1.022 0.985~1.061 0.249 球蛋白/(g·L-1) 53.23±30.18 0.991 0.981~1.000 0.047 A/G 1.06±0.84 1.241 0.937~1.643 0.132 LDH/(U·L-1) 202.54±84.30 1.003 1.000~1.006 0.081 血清钙/(mmol·L-1) 2.38±0.44 1.038 0.576~1.872 0.901 血清校正钙/(mmol·L-1) 2.45±0.44 0.999 0.555~1.798 0.997 血肌酐/(μmol·L-1) 151.37±172.39 1.001 1.000~1.002 0.190 血清β2-MG/(μg·mL-1) 4.72±4.13 1.040 0.979~1.105 0.204 尿β2-MG/(μg·mL-1) 2.21±3.54 1.015 0.934~1.013 0.724 补体C3/(mg·mL-1) 0.94±0.27 1.152 0.435~3.052 0.776 补体C4/(mg·mL-1) 0.23±0.17 4.396 1.077~17.941 0.039 M蛋白/(g·L-1) 30.32±20.64 0.995 0.981~1.010 0.547 骨髓浆细胞比例/% 33.75±20.91 1.006 0.996~1.017 0.248 ISS分期/例(%) Ⅰ 39(35.14) 0.307 Ⅱ 44(39.64) 0.740 0.403~1.361 0.333 Ⅲ 28(25.22) 1.243 0.657~2.351 0.504 一线治疗方案/例(%) 含硼替佐米 95(85.59) 1.048 0.515~2.135 0.897 不含硼替佐米 16(14.41) 多因素分析 年龄 1.044 1.013~1.076 0.005 补体C4/(mg·mL-1) 5.994 1.309~27.442 0.021 
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表 2 影响患者2年生存期的单因素分析
参数 2年生存组(n=77) 2年死亡组(n=34) HR(95%CI) P 性别/例 0.603(0.265~1.374) 0.229 男 38 21 女 39 13 年龄/岁 61.23±9.91 65.88±8.40 1.057(1.008~0.018) 0.022 血红蛋白/(g·L-1) 87.25±24.03 83.53±28.53 0.994(0.978~1.010) 0.477 白细胞计数/(×109·L-1) 5.14±2.16 4.12±1.52 0.643(0.480~0.862) 0.003 中性粒细胞/(×109·L-1) 3.54±1.74 2.72±1.30 1.012(0.943~1.106) 0.608 淋巴细胞/(×109·L-1) 1.44±0.68 1.13±0.56 0.394(0.171~0.910) 0.029 血小板计数/(×109·L-1) 170.60±75.74 136.74±68.40 0.993(0.987~0.999) 0.031 白蛋白/(g·L-1) 35.96±6.69 36.14±7.78 1.004(0.947~1.064) 0.889 球蛋白/(g·L-1) 55.01±32.25 49.19±24.86 0.993(0.980~1.007) 0.348 A/G 1.06±0.87 1.06±0.78 0.996(0.615~1.613) 0.985 LDH/(U·L-1) 195.32±76.86 218.68±98.28 1.003(0.998~1.008) 0.185 血清钙/(mmol·L-1) 2.36±0.39 2.43±0.54 1.410(0.576~3.450) 0.451 血清校正钙/(mmol·L-1) 2.43±0.40 2.51±0.54 1.520(0.641~3.763) 0.365 血肌酐/(μmol·L-1) 139.64±142.74 178.73±227.46 1.001(0.999~1.003) 0.285 血清β2-MG/(μg·mL-1) 4.63±3.94 4.92±4.59 1.017(0.922~1.122) 0.740 尿β2-MG/(μg·mL-1) 1.85±2.63 3.01±5.01 1.090(0.957~1.241) 0.197 补体C3/(mg·mL-1) 0.94±0.28 0.93±0.27 0.772(0.174~3.421) 0.734 补体C4/(mg·mL-1) 0.21±0.15 0.28±0.20 11.775(1.088~127.462) 0.042 M蛋白/(g·L-1) 36.50±21.40 39.40±18.85 1.007(0.984~1.031) 0.558 骨髓浆细胞比例/% 31.69±21.11 38.50±19.95 1.015(0.996~1.036) 0.127 ISS/例(%) Ⅰ 27(24.32) 12(10.81) 0.958 Ⅱ 30(27.03) 14(12.61) 1.050(0.414~2.661) 0.918 Ⅲ 20(18.02) 8(7.21) 0.900(0.310~2.611) 0.846
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