Effect of serum prealbumin level on prognosis of newly diagnosed patients with multiple myeloma
-
摘要: 目的 探讨血清前白蛋白(prealbumin，PA)水平对初诊多发性骨髓瘤(multiple myeloma，MM)患者预后的影响。方法 纳入医院2014年1月—2020年12月收治的初诊MM患者进行前瞻性队列研究，根据患者初诊时血清PA的中位数，分为低水平组和高水平组，绘制2组生存曲线，比较2年生存状况；同时应用Cox比例风险模型进一步分析血清PA对初诊MM患者预后的影响。结果 共入选83例患者，其中2例失访，1例中途放弃治疗，最终80例患者进入研究。80例MM患者血清PA中位数为13.64 mg/dL，低水平组单核细胞计数、淋巴细胞计数、血小板计数、白蛋白水平低于高水平组，C反应蛋白水平高于高水平组(P < 0.05)。高、低血清PA水平患者生存时间分别为(22.89±0.45)个月、(19.17±1.13)个月，低血清PA水平患者2年生存时间明显低于高水平组(χ2=6.400，P=0.001)。无论是否调整混杂因素，血清PA低表达均可增加MM患者病死的风险(P < 0.05)；且每增加2 mg/dL血清PA，MM患者2年病死的风险明显降低(P < 0.05)。结论 血清PA是影响初诊MM患者预后的独立危险因素。Abstract: Objective To explore the effect of serum prealbumin(PA) level on the prognosis of newly diagnosed patients with multiple myeloma(MM).Methods A prospective cohort study was carried out among the newly diagnosed MM patients admitted to the hospital from January 2014 to December 2020. According to the median of serum PA at the time of initial diagnosis, the patients were divided into low level group and high level group. The survival curves of the two groups were drawn and the two-year survival status was compared. At the same time, Cox proportional risk model was used to further analyze the influence of serum PA on the prognosis of newly diagnosed MM patients.Results A total of 83 patients were enrolled, of which 2 case were lost, 1 case gave up treatment halfway, and finally 80 patients entered the study. The median of serum PA in 80 patients with MM was 13.64 mg/dL. The levels of monocyte count, lymphocyte count, platelet count and albumin in the low level group were lower than those in the high level group, and the level of C-reactive protein was higher than that in the high level group(P < 0.05). The survival time of patients with high and low serum PA levels was (22.89±0.45) months and (19.17±1.13) months, respectively. The 2-year survival time of patients with low serum PA level was significantly lower than that of patients with high serum PA level(χ2=6.400, P=0.001). Whether or not the confounding factors were adjusted, the low expression of serum PA could increase the risk of death in MM patients(P < 0.05). The risk of death of patients with MM decreased significantly by 2 mg/dL of serum PA increased for 2 years (P < 0.05).Conclusion Serum PA may be an independent risk factor affecting the prognosis of newly diagnosed MM patients.
-
Key words:
- multiple myeloma /
- prealbumin /
- prognosis
-
-
表 1 不同血清PA水平患者临床资料分析
变量 血清PA水平 统计值 P 低水平组(n=36) 高水平组(n=44) 性别/例 χ2=0.019 0.892 男 21 25 女 15 19 年龄/岁 58.67±3.48 58.20±3.41 t=0.597 0.552 M蛋白分型/例 χ2=0.202 0.653 IgG型 19 21 非IgG型 17 23 ISS分期/例 Z=0.099 0.921 Ⅰ期 7 9 Ⅱ期 14 17 Ⅲ期 15 18 DS分期/例 Z=0.353 0.724 Ⅰ期 6 7 Ⅱ期 7 7 Ⅲ期 23 30 AMC/(×109/L) 0.31±0.08 0.42±0.10 t=5.597 < 0.001 ALC/(×109/L) 1.25±0.25 1.67±0.26 t=7.458 < 0.001 PLT/(×109/L) 130.67±12.33 159.85±12.64 t=10.382 < 0.001 CRP/(mg/L) 8.21±1.63 6.37±1.45 t=5.295 < 0.001 β2-MG/(g/L) 3.27±1.01 3.31±0.96 t=0.137 0.891 LDH/(U/L) 187.66±10.36 190.01±10.54 t=1.000 0.320 Hb/(g/L) 79.62±8.64 82.33±8.82 t=1.385 0.170 ALB/(g/L) 32.54±4.27 40.61±4.43 t=8.237 < 0.001 Cr/(μmol/L) 150.34±12.78 148.63±12.54 t=0.602 0.549 
下载: 导出CSV
表 2 血清PA水平影响初诊MM患者预后的风险比
变量 血清PA水平 P 低水平组 高水平组 例数 36 44 - 事件数 14 7 0.001 模型1 0.696(0.611~0.793) 1 < 0.001 模型2 0.653(0.553~0.769) 1 < 0.001 模型3 0.652(0.553~0.768) 1 < 0.001 模型1：未校正任何因素；模型2：校正AMC、ALC、PLT、ALB；模型3：校正AMC、ALC、PLT、ALB、CRP。
下载: 导出CSV
表 3 每增加2 mg/dL血清PA水平患者病死率的风险比例
项目 每增加2 mg/dL血清PA(n=80) P 模型1 0.524(0.422~0.650) < 0.001 模型2 0.509(0.396~0.653) < 0.001 模型3 0.508(0.395~0.653) < 0.001 模型1：未校正任何因素；模型2：校正AMC、ALC、PLT、ALB；模型3：校正AMC、ALC、PLT、ALB、CRP。
下载: 导出CSV
-
[1] 赵晶, 刘海波, 习杰英. 多发性骨髓瘤患者中LncRNA DAPK1-IT1的表达与其临床意义研究[J]. 临床血液学杂志, 2022, 35(3): 190-194. doi: 10.13201/j.issn.1004-2806.2022.03.008
[2] Abdallah NH, Binder M, Rajkumar SV, et al. A simple additive staging system for newly diagnosed multiple myeloma[J]. Blood Cancer J, 2022, 12(1): 21. doi: 10.1038/s41408-022-00611-x
[3] Hanamura I. Multiple myeloma with high-risk cytogenetics and its treatment approach[J]. Int J Hematol, 2022, 115(6): 762-777.
[4] 何建冰, 段红兵, 康健乐, 等. 食管癌病人围手术期营养状况对其术后恢复的影响[J]. 肠外与肠内营养, 2021, 28(2): 75-78. doi: 10.16151/j.1007-810x.2021.02.003
[5] Nuchit S, Lam-Ubol A, Paemuang W, et al. Alleviation of dry mouth by saliva substitutes improved swallowing ability and clinical nutritional status of post-radiotherapy head and neck cancer patients: a randomized controlled trial[J]. Support Care Cancer, 2020, 28(6): 2817-2828. doi: 10.1007/s00520-019-05132-1
[6] 王晓敏, 林晓珂, 施晴谊, 等. 术前营养对老年口腔鳞状细胞癌患者预后的影响[J]. 福建医科大学学报, 2022, 56(5): 408-413. https://www.cnki.com.cn/Article/CJFDTOTAL-FJYD202205007.htm
[7] 李军根, 陆士奇, 肖接承, 等. 血清C反应蛋白/前白蛋白比值对重型颅脑外伤患者预后的预测价值[J]. 中国急救医学, 2022, 42(9): 760-764. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJJY202209005.htm
[8] 中国医师协会血液科医师分会, 中华医学会血液学分会, 中国多发性骨髓瘤工作组. 中国多发性骨髓瘤诊治指南(2013年修订)[J]. 中华内科杂志, 2013, 52(9): 791-795. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201611020.htm
[9] Vitale I, Manic G, Coussens LM, et al. Macrophages and metabolism in the tumor microenvironment[J]. Cell Metab, 2019, 30(1): 36-50.
[10] Hinshaw DC, Shevde LA. The tumor microenvironment innately modulates cancer progression[J]. Cancer Res, 2019, 79(18): 4557-4566.
[11] 林家俞, 秦洁洁, 蒋玲曦. 肿瘤微环境中免疫细胞的代谢研究进展[J]. 上海交通大学学报(医学版), 2022, 42(8): 1122-1130. https://www.cnki.com.cn/Article/CJFDTOTAL-SHEY202208018.htm
[12] Smith SH. Using albumin and prealbumin to assess nutritional status[J]. Nursing, 2017, 47(4): 65-66.
[13] 侯忠衡, 张磊, 王祁, 等. 术前血清前白蛋白对TACE治疗不可切除肝细胞癌患者预后的预测价值[J]. 介入放射学杂志, 2022, 31(6): 587-592. https://www.cnki.com.cn/Article/CJFDTOTAL-JRFS202206012.htm
[14] 宗立翎, 杨晶, 薛胜利, 等. 急性白血病患者化疗期间营养状况变化的观察研究[J]. 中国实验血液学杂志, 2022, 30(4): 1028-1033. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY202204009.htm
[15] 闫可, 魏菀怡, 杨洁, 等. 系统免疫炎症指数联合临床分期对食管癌患者预后的预测价值[J]. 中华放射医学与防护杂志, 2022, 42(1): 25-31.
[16] Swamydas M, Murphy EV, Ignatz-Hoover JJ, et al. Deciphering mechanisms of immune escape to inform immunotherapeutic strategies in multiple myeloma[J]. J Hematol Oncol, 2022, 15(1): 17.
[17] Blimark C, Holmberg E, Mellqvist UH, et al. Multiple myeloma and infections: a population-based study on 9253 multiple myeloma patients[J]. Haematologica, 2015, 100(1): 107-113.
[18] Augustson BM, Begum G, Dunn JA, et al. Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United Kingdom Medical Research Council trials between 1980 and 2002—Medical Research Council Adult Leukaemia Working Party[J]. J Clin Oncol, 2005, 23(36): 9219-9226.
[19] 张金冉, 魏海梁, 王庆庆, 等. 多因素综合血管性痴呆伴肺部感染患者发生营养不良预测模型的构建[J]. 医学综述, 2020, 26(24): 4962-4967. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS202024035.htm
[20] Triarico S, Rinninella E, Cintoni M, et al. Impact of malnutrition on survival and infections among pediatric patients with cancer: a retrospective study[J]. Eur Rev Med Pharmacol Sci, 2019, 23(3): 1165-1175.
-
图(1)
表(3)
计量
- 文章访问数: 422
- PDF下载数: 196
- 施引文献: 0