多发性骨髓瘤的预后评估和多因素模型的建立

目的 分析78例多发性骨髓瘤(MM)患者的年龄，生化和骨髓等18项临床和实验室指标，希望得到简单易行的预后因素。方法 对18项临床和实验室指标(年龄、性别、病期和血液学、血清学检查等)进行了单因素和多因素分析。结果 78例患者的中位生存期38个月，单因素分析发现年龄，血红蛋白，血清钙离子浓度，血清肌酐与预后相关；在多因素分析中，3个独立因素与预后差密切联系并由此建立预后模型：1．年龄大于65岁；2．高浓度血清钙；3．骨髓中原始 幼稚浆细胞的比例增多。该78例患者根据上述预后模型重新分组，发现低危险性组患者的中位生存期(44个月)明显长于中度危险组(27个月)和高危险组(10个月)。结论 初诊MM患者有必要在治疗前接受简单易行的预后分析并分组，从而制定相应治疗方案。

Assessment on the prognosis of multiple myeloma and establishment of a multifactor model

Objective Clinical and laboratory indexes from 78 multiple myeloma patients were analized for the factors that may influence the prognosis. Methods Eighteen indexes (age, sex, stage, biochemical and bone marrow indexes, etc.) were underwent single and multiple factors analyses. Results The median survival time of 78 patients was 38 months. The significant single pre-treatment prognostic factors for long-term survival were age, Ca ++ , Hb and creatinine. In a multivariate Cox analysis 3 variables were significantly and independently associated with poor outcome: high age, high serum levels of calcium, and the proportion of immature + plasmablastic myeloma cells in bone marrow. 78 cases were divided into 3 risk groups according to the risk score, the patients in low-risk had better survival time (44 months) than the ones in mediate-risk (27 months) and in high-risk (10 months). Conclusion The risk score formed on the independent variables should be done at the primary diagnosis, and the patients in different risk groups should be given distinct therapy.