血清胱抑素C在多发性骨髓瘤预后中的意义

目的 探讨血清胱抑素C（Cys-C）在多发性骨髓瘤（MM）预后中的意义.方法 收集初诊MM患者160例,平均年龄61.38岁,治疗前检测Cys-C、血清肌酐、β2-微球蛋白（β2-MG）、乳酸脱氢酶（LDH）及血红蛋白水平;中位随访38个月,观察Cys-C与总生存（OS）、无事件生存（EFS）的关系.结果 160例MM患者Cys-C水平为（0.96±0.32） mg/L,高于80例健康对照组的（0.71±0.16）mg/L（P＜0.000）;按ISS分期,Ⅰ期患者Cys-C水平为（0.70±0.13）mg/L,Ⅱ期为（0.87±0.16）mg/L,Ⅲ期为（1.23±0.33）mg/L,各期间Cys-C水平差异均有统计学意义（均P＜0.05）;Cys-C与血清肌酐、β2-MG、LDH呈正相关（r=0.669,r=0.672,r=0.521;均P＜ 0.000）,与血红蛋白呈负相关（r=-0.436,P＜ 0.000）.用ROC分析,Cys-C水平＞0.95 mg/L的患者和Cys-C≤0.95 mg/L的患者相比有较短的EFS和OS（中位EFS分别为30、57个月,P＜0.05;中位OS分别为43、68个月,P＜0.05）.结论 对于MM患者,Cys-C不仅是反应肾损害的敏感指标,也是反应肿瘤负荷及判断预后的指标之一.

Prognostic significance of serum cystatin C in multiple myeloma

Objective To investigate the prognostic significance of serum cystatin C in multiple myeloma （MM）.Methods 160 cases of newly diagnosed MM patients with average age of 61.38 years old.Determine the levels of serum cystatin C,serum creatinine,β 2-microglobulin,lactate dehydrogenase and hemoglobin before the treatment; median follow-up of 38 months,observe the relationship between serum cystatin C with overall survival （OS） and event-free survival （EFS）.Results Median serum cystatin C level in 160 MM patients was higher than that in the 80 healthy controls （0.96 ± 0.32） mg/L vs （0.71 ± 0.16） mg/L,P ＜ 0.000].All the patients in ISS stage were divided into 3 stages.Median serum cystatin C levels significantly increased in higher ISS stages stage Ⅰ （0.70±0.13） mg/L,stage Ⅱ （0.87±0.16） mg/L,stage Ⅲ（1.23±0.33） mg/L （P ＜ 0.05）],serum cystatin C level was positively correlated with levels of serum creatinine （r =0.669,P ＜ 0.000）,β2-microglobulin （r =0.672,P ＜ 0.000）.lactate dehydrogenase （r =0.521,P ＜ 0.000）,and negatively correlated with hemoglobin levels （r =-0.436,P ＜ 0.000）.Using ROC analysis,patients with serum cystatin C levels ＞ 0.95 mg/L had significantly shorter EFS and OS patients with serum cystatin C levels ≤0.95 mg/L （median EFS：30 vs 57 months,P ＜ 0.05; median OS：43 vs 68 months,P ＜ 0.05）.Conclusion Serum cystain C is not only a sensitive marker of kidney damage,but also reflects tumor burden and delivers prognostic information in MM.