血清血小板因子4对采用沙利度胺联合VCD治疗的新发多发性骨髓瘤患者疗效的预测价值

目的 探究血清血小板因子4(serum platelet factor 4，PF4)对采用沙利度胺联合VCD(硼替佐米、环磷酰胺、地塞米松)治疗的新发多发性骨髓瘤(MM)患者疗效的预测价值。 方法 选取2016年1月—2018年12月在温州市中心医院收治的MM患者120例为研究对象，所有患者均予以沙利度胺联合VCD治疗，共4个疗程，根据治疗结束后治疗反应性将患者分为反应组及对照组，比较2组一般资料、血生化检查及PF4水平，应用logistic回归分析对治疗反应性的独立危险因素进行分析；应用ROC曲线评估不同指标指标对治疗反应性的预测效能。 结果 经治疗有反应的患者共88例(73.33%)，反应组与对照组在ISS分级、Del17p方面差异有统计学意义(均P＜0.05)，反应组β2微球蛋白、血肌酐水平显著低于对照组(t=3.841、2.430，均P＜0.05)，反应组PF4水平显著高于对照组(t=5.556，P＜0.001)；多因素logistic回归显示低水平β2微球蛋白是治疗反应性的独立保护因素(OR=0.062，P=0.005)，低水平PF4是治疗反应性的独立危险因素(OR=1.107，P=0.001)；PF4及β2微球蛋白预测治疗反应性的最佳截点分别为＞736.293 ng/L，≤3.597 mg/dL，其AUC分别为0.874、0.756，PF4显著优于β2微球蛋白(Z=2.097，P=0.036)；PF4具有较好的特异度，β2微球蛋白具有较好的灵敏度(均P＜0.05)。 结论 PF4对采用沙利度胺联合VCD治疗的新发多发性骨髓瘤患者疗效具有一定的预测价值，最佳截点为＞736.29 ng/L。 

Predictive value of serum platelet factor 4 (PF4) for the efficacy of new multiple myeloma patients treated with thalidomide combined VCD

Objective To explore the predictive value of serum platelet factor 4 (PF4) for the efficacy of new multiple myeloma (MM) patients treated with thalidomide combined VCD. Methods A total of 120 MM patients in Wenzhou Central Hospital from January 2016 to December 2018 were selected as study subjects. All patients were treated with thalidomide combined with VCD for 4 courses, and then divided into reaction group and control group according to the therapeutic response after treatment. The general data, blood biochemical examination and PF4 level of the two groups were compared. Logistic regression was used to analyze independent risk factors for treatment response. ROC curve was used to evaluate the predictive efficacy of different indicators on treatment response. Results Eighty-eight patients (73.33%) responded to the treatment. There were significant differences in ISS grading and Del17p between the reaction group and the control group (P<0.05). The levels of β2 microglobulin and serum creatinine in the reaction group were significantly lower than control group (t=3.841, 2.430, all P<0.05). The level of PF4 in the response group was significantly higher than the control group (t=5.556, P＜0.001). Multivariate logistic regression showed that low levels of β2 microglobulin were independent protective factors for treatment response (OR=0.062, P=0.005), and low levels of PF4 were independent risk factors for treatment response (OR=1.107, P=0.001). The best cut-off points of PF4 and β2 microglobulin for predicting treatment response were ＞736.29 ng/L and ≤3.597 mg/dL, and the AUC were 0.874 and 0.756, respectively. PF4 was significantly better than β2 microglobulin (Z=2.097, P=0.036). PF4 had better sensitivity and β2 microglobulin had better specificity (P＜0.05). Conclusion PF4 has predictive value for the efficacy of new MM treated with thalidomide combined VCD, with the best cut-off points of ＞736.29 ng/L.