炎症指标及CD4<sup>+</sup>/CD8<sup>+</sup>对新诊断多发性骨髓瘤患者的预后研究

蒋溪媛; 席亚明

doi:10.13201/j.issn.1004-2806.2025.01.010

炎症指标及CD4⁺/CD8⁺对新诊断多发性骨髓瘤患者的预后研究

蒋溪媛¹,
席亚明^2, ,

- 1.
  兰州大学第一临床医学院(兰州，730030)
- 2.
  兰州大学第一医院血液科

详细信息

通讯作者: 席亚明，E-mail：xiyaming02@163.com

中图分类号: R733.3

收稿日期: 2024-08-05

修回日期: 2024-11-25

刊出日期: 2025-01-01

Study on prognostic value of inflammation markers and CD4⁺/CD8⁺ ratio in newly diagnosed multiple myeloma patients

JIANG Xiyuan¹,
XI Yaming^2, ,

- 1.
  The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, China
- 2.
  Department of Hematology, the First Hospital of Lanzhou University

More Information

Corresponding author: XI Yaming, E-mail: xiyaming02@163.com

Received Date: 05 August 2024

Revised Date: 25 November 2024

Publish Date: 01 January 2025

摘要

摘要: 目的分析新诊断多发性骨髓瘤(newly diagnosed multiple myeloma，NDMM)患者的临床特征并探究中性粒细胞与淋巴细胞比(NLR)、血小板-淋巴细胞比(PLR)、淋巴细胞-单核细胞比(LMR)、CD4⁺/CD8⁺对于NDMM患者预后的影响。方法回顾性分析2013年1月—2023年12月就诊于兰州大学第一医院的141例NDMM患者的临床资料，收集其一般资料、临床特征、辅助检查、诊断治疗及疗效预后并计算NLR、PLR、LMR、CD4⁺/CD8⁺。结果通过受试者工作特征(ROC)曲线分别计算出最佳截断值(NLR：2.143，PLR：85.236，LMR：2.584，CD4⁺/CD8⁺：0.780)，根据此数据分为高NLR组、低NLR组，高PLR组、低PLR组，高LMR组、低LMR组，高CD4⁺/CD8⁺组、低CD4⁺/CD8⁺组，并与临床资料比较，得到血钙(Ca²⁺)及乳酸脱氢酶(LDH)对于NLR存在影响(P < 0.05)；β2微球蛋白(β2-MG)对于PLR存在影响(P < 0.05)；年龄、血小板计数(PLT)、Ca²⁺、LDH、β2-MG、FISH检测是否异常对于LMR存在影响(P < 0.05)；PLT、肌酐(Cr)、Ca²⁺、FISH检测是否异常对于CD4⁺/CD8⁺存在影响。治疗效果数据显示，与高NLR组患者相比，低NLR组患者治疗成效明显更为优秀。多因素分析显示，在NDMM患者中，年龄以及NLR被证实是与总生存期和无进展生存期预后显著相关的独立危险因素(P < 0.05)。结论 NLR、LMR、CD4⁺/CD8⁺对于预测NDMM患者预后有重要意义。
- 新诊断多发性骨髓瘤 /
- 临床特征 /
- 中性粒细胞与淋巴细胞比 /
- CD4⁺/CD8⁺
Abstract: Objective To analyze the clinical characteristics of newly diagnosed multiple myeloma(NDMM) patients and explore the effects of neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR), lymphocyte to monocyte ratio(LMR), and CD4⁺/CD8⁺ on prognosis.Methods A retrospective analysis was conducted on the clinical data of 141 NDMM patients in the First Hospital of Lanzhou University from January 2013 to December 2023. General information, clinical characteristics, auxiliary examinations, diagnosis, treatment, and prognosis were collected, and NLR, PLR, LMR, CD4⁺/CD8⁺ were calculated.Results The optimal cut-off values(NLR: 2.143, PLR: 85.236, LMR: 2.584, CD4⁺/CD8⁺: 0.780) divided patients into high and low groups(high NLR group, low NLR group, high PLR group, low PLR group, high LMR group, low LMR group, high CD4⁺/CD8⁺ group, low CD4⁺/CD8⁺ group), and by comparing with clinical data, it was found that blood calcium(Ca²⁺) and lactate dehydrogenase(LDH) levels have an impact on NLR(P < 0.05); β2-MG level has an impact on PLR(P < 0.05); Whether age, platelet count(PLT), Ca²⁺, LDH, β2-MG, and FISH detection are abnormal have an impact on LMR(P < 0.05); Abnormalities in PLT, creatinine(Cr), Ca²⁺, and FISH detection have an impact on CD4⁺/CD8⁺. The treatment efficacy data shows that patients in the low NLR group have significantly better treatment outcomes compared with patients in the high NLR group. Multivariate analysis showed that age and NLR were significantly independent risk factors associated with overall survival and progression free survival in NDMM patients(P < 0.05).Conclusion NLR, LMR, CD4⁺/CD8⁺ are of great significance in predicting the prognosis of NDMM patients.
- newly diagnosed multiple myeloma /
- clinical features /
- neutrophil-to-lymphocyte ratio /
- CD4⁺/CD8⁺

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图 1 NDMM患者NLR、PLR、LMR、CD4⁺/CD8⁺的ROC曲线

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图 2 NLR与OS及PFS生存曲线

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图 3 PLR与OS及PFS生存曲线

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图 4 LMR与OS及PFS生存曲线

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图 5 CD4⁺/CD8⁺与OS及PFS生存曲线

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表 1 NDMM患者临床资料

临床资料	例数(%)	临床资料	例数(%)
年龄		M蛋白类型
< 65岁	77(54.6)	IgG型	76(53.9)
≥65岁	64(45.4)	IgA型	36(25.5)
性别		轻链型	21(14.9)
男	77(54.6)	IgD型	6(4.3)
女	64(45.4)	不分泌型	1(0.7)
Hb < 100 g/L	95(67.4)	IgM型	1(0.7)
PLT < 100×10⁹/L	45(31.9)	ISS分期
Cr≥177 μmol/L	26(18.4)	Ⅰ期	18(12.8)
Ca²⁺≥2.75 mmol/L	21(14.9)	Ⅱ期	48(34.0)
β2-MG≥5.5 mg/L	70(49.6)	Ⅲ期	75(53.2)
UA≥420 μmol/L	58(41.1)	BMPC
LDH≥250 U/L	27(19.1)	< 30%	42(29.8)
髓外病变	10(7.1)	≥30%	99(70.2)
注：Hb：血红蛋白；UA：尿酸；PLT：血小板计数；Cr：肌酐。

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表 2 NLR、PLR、LMR、CD4⁺/CD8⁺水平与临床资料之间的关系例

临床资料	NLR			PLR			LMR			CD4⁺/CD8⁺
临床资料	< 2.143	≥2.143	P	< 85.236	≥85.236	P	< 2.584	≥2.584	P	< 0.780	≥0.780	P
年龄/岁			0.108			0.340			0.007			0.773
< 65	56	21		25	42		21	56		13	64
≥65	38	26		24	40		6	58		12	52
性别			0.120			0.940			0.453			0.298
男	47	30		32	45		13	64		16	61
女	47	17		27	37		14	50		9	55
ISS分期			0.152			0.090			0.258			0.566
Ⅰ/Ⅱ期	48	18		20	46		10	56		13	53
Ⅲ期	46	29		39	36		17	58		12	63
Hb/(g/L)			0.899			0.122			0.200			0.311
< 100	63	32		44	51		21	74		19	76
≥100	31	15		15	31		6	40		6	40
PLT(×10⁹/L)			0.125			< 0.001			0.003			0.004
< 100	26	19		30	15		15	30		14	31
≥100	68	28		29	67		12	84		11	85
Cr/(μmol/L)			0.125			0.351			0.095			0.049
< 177	80	35		46	69		19	95		17	98
≥177	14	12		13	13		8	18		8	18
UA/(μmol/L)			0.090			0.101			0.090			0.224
< 420	60	23		30	53		12	71		12	71
≥420	34	24		29	29		15	43		13	45
Ca²⁺/(mmol/L)			0.045			0.561			0.017			0.001
< 2.75	84	33		48	71		19	101		15	105
≥2.75	10	14		10	11		8	13		10	11
LDH/(U/L)			0.023			0.761			0.002			0.215
< 250	81	33		47	67		16	98		18	96
≥250	13	14		12	15		11	16		7	20
β2-MG/(mg/L)			0.190			0.008			0.017			0.795
< 5.5	51	20		22	49		8	63		12	59
≥5.5	43	27		37	33		19	51		13	57
FISH			0.404			0.099			0.039			0.021
正常	52	23		36	39		9	66		8	66
异常	42	24		23	43		17	49		17	50

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表 3 不同NLR、PLR、LMR、CD4⁺/CD8⁺水平与临床疗效之间的关系例

分组	有效	无效	χ²	P
低NLR组	73	21	15.335	< 0.001
高NLR组	21	26
低PLR组	44	15	2.856	0.091
高PLR组	50	32
低LMR组	23	15	3.298	0.069
高LMR组	71	32
低CD4⁺/CD8⁺组	13	12	2.942	0.086
高CD4⁺/CD8⁺组	81	35

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表 4 影响OS、PFS危险因素的单因素分析

影响因素	OS		PFS
影响因素	95%CI	P	95%CI	P
性别	0.142~0.993	0.028	0.154~1.032	0.058
年龄	1.594~10.547	0.002	1.716~12.903	0.003
ISS分期	1.268~8.411	0.014	1.369~10.269	0.010
Hb	1.286~8.411	0.011	0.044~0.807	0.025
PLT	0.034~0.298	< 0.001	0.035~0.308	< 0.001
NLR	5.273~61.278	< 0.001	5.992~70.649	< 0.001
PLR	0.856~5.740	0.093	0.909~6.793	0.066
LMR	0.050~0.284	< 0.001	0.049~0.282	< 0.001
Cr	1.265~7.575	0.009	1.202~7.012	0.018
UA	1.263~7.673	0.009	1.269~7.798	0.013
Ca²⁺	2.643~14.237	< 0.001	3.232~18.870	< 0.001
LDH	1.890~10.505	0.001	1.800~9.995	0.001
β2-MG	1.339~9.848	0.011	1.304~9.597	0.013
CD4⁺/CD8⁺	0.101~0.539	0.001	0.087~0.486	< 0.001
FISH	1.758~20.380	0.004	2.103~24.310	0.002

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表 5 影响OS、PFS危险因素的多因素分析

影响因素	OS		PFS
影响因素	95%CI	P	95%CI	P
性别	0.276~4.909	0.835
年龄	1.772~40.003	0.007	1.708~40.232	0.009
ISS分期	0.151~3.474	0.687	0.549~11.831	0.223
Hb	0.053~6.157	0.646	0.061~3.228	0.422
PLT	0.020~0.506	0.005	0.025~0.668	0.012
NLR	2.098~74.782	0.006	1.571~41.298	0.012
LMR	0.134~1.813	0.287	0.099~1.303	0.360
Cr	0.793~8.353	0.115	0.804~6.903	0.118
UA	0.138~2.400	0.449	0.216~2.8 968	0.724
Ca²⁺	0.483~3.868	0.556	0.356~3.980	0.777
LDH	0.299~3.225	0.977	0.299~3.061	0.942
β2-MG	0.166~6.383	0.976	0.066~2.298	0.298
CD4⁺/CD8⁺	0.108~1.557	0.190	0.101~1.438	0.155
FISH	0.440~16.482	0.284	0.622~10.781	0.191

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