摘要
目的探讨血中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、β_(2)-微球蛋白(β_(2)-microglobulin,β_(2)-MG)及胱抑素C(cystatin C,Cys-C)对初诊多发性骨髓瘤(multiple myeloma,MM)患者合并肾损伤(renal impairment,RI)的预测价值。方法回顾性分析2013年1月至2020年12月烟台市烟台山医院收治的初诊为MM的患者97例,按照血肌酐水平将MM患者分为RI组(22例)(血肌酐>176.80 mmol/L)及非RI组(75例)(血肌酐≤176.80 mmol/L)。对比分析RI组和非RI组临床分型及实验室指标。采用Logistic回归法分析MM发生RI的危险因素,应用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估各危险因素对MM患者发生RI的预测价值。结果97例初诊MM患者发生RI者占22.70%,RI组轻链型比例最高,比例最低者为免疫球蛋白(immunoglobulin,Ig)G-κ型和IgA-λ型,非RI组IgG-κ型最多,比例最低者为IgA-λ型。与RI组相比,非RI组血红蛋白(hemoglobin,HB)和红细胞(red blood cell,RBC)表达明显升高,血清碱性磷酸酶(alkaline phosphatase,ALP)、外周血白细胞(white blood cell,WBC)、血清唾液酸(sialic acid,SA)、单核细胞与淋巴细胞比值(mtolymphocyte ratio,MLR)、NLR、Cys-C、β_(2)-MG表达明显降低,差异均有统计学意义(t/z值分别为-2.54、-2.80、1.97、2.49、2.61、2.70、3.66、6.22、6.03,P值均<0.05)。二元logistic单因素回归分析结果显示,WBC、RBC、HB、ALP、NLR、MLR、Cys-C、β_(2)-MG是MM RI的危险因素,而SA对MM RI无显著影响。二元logistic多因素回归分析发现,NLR≥1.92,β_(2)-MG≥6.66 mg/L,Cys-C≥1.66 mg/L是MM RI的独立危险因素。NLR、β_(2)-MG、Cys-C预测MM RI的敏感度分别为0.77、0.73、0.91,特异度分别为0.68、0.99、0.87。NLR、β_(2)-MG、Cys-C联合检测的敏感度为0.91,特异度为0.96。结论NLR、β_(2)-MG、Cys-C均能较好地预测初诊MM患者发生RI的可能,与单独检测相比,三个指标联合检测对MM RI具有更高的预测价值。
Objective To explore the predictive value of serum neutrophil to lymphocyte ratio(NLR),β_(2)-microglobulin(β_(2)-MG)and cystatin C(Cys-C)in patients with initially diagnosed multiple myeloma(MM)complicated with renal impairment(RI).Methods A retrospective analysis was performed in 97 patients with MM who were initially diagnosed in Yantaishan Hospital from January 2013 to December 2020.According to the serum creatinine level,the MM patients were divided into the RI group(22 cases)(blood creatinine>176.80 mmol/L)and the non-RI group(75 cases)(blood creatinine≤176.80 mmol/L).The clinical classification and laboratory indexes of RI group and non-RI group were compared and analyzed.Binary logistic regression was used to analyze the risk factors of RI in MM patients.Receiver operating characteristic curve(ROC)was used to evaluate the predictive value of each risk factor of RI in MM patients.Results The incidence of RI in 97 newly diagnosed MM patients was 22.70%.In RI group,the proportion of light chain type was the highest,and the lowest proportion was immunoglobulin G-κtype and IgA-λtype,while the non RI group had the highest proportion of immunoglobulin(Ig)G-κtype,and the lowest proportion was IgA-λtype.Compared with RI group,the expression of hemoglobin(HB)and red blood cell(RBC)increased significantly,while serum alkaline phosphatase(ALP),white blood cell(WBC),sialic acid(SA),monocyte to lymphocyte ratio(MLR),NLR,Cys-C,β_(2)MG decreased significantly in non RI group(t/z values were-2.54,-2.80,1.97,2.49,2.61,2.70,3.66,6.22 and 6.03 respectively,all P values<0.05).The results of binary logistic single factor regression analysis showed that WBC,RBC,HB,ALP,NLR,MLR,Cys-C andβ_(2)-MG were risk factors of MM RI,while SA had no significant effect on MM RI.The binary logistic multiple factor regression analysis found that NLR≥1.92,β_(2)-MG≥6.66 mg/L and Cys-C≥1.66 mg/L were independent risk factors of MM RI.ROC curve analysis showed that the sensitivity of NLR,β_(2)-MG and Cys-C to predict MM RI was 0.77
作者
厉吉霞
郭楠
于传亭
杨建
Li Jixia;Guo Nan;Yu Chuanting;Yang Jian(Department of Clinical Laboratory,Yantaishan Hospital,Yantai 264003,China;Yantai Central Station,Yantai 264003,China)
出处
《国际免疫学杂志》
CAS
2023年第1期38-44,共7页
International Journal of Immunology
