中性粒细胞/淋巴细胞比值及单核细胞/淋巴细胞比值在多发性骨髓瘤患者中的预后意义

目的:研究中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)对多发性骨髓瘤(MM)患者预后的影响。方法:回顾性分析甘肃省人民医院收治的初发MM患者82例,根据血常规结果分别计算出NLR、MLR;根据患者工作特征曲线(ROC曲线)分别确定NLR和MLR的最佳截断点,将患者分为高NLR组、低NLR组和高MLR组、低MLR组,分别比较各组患者的一般资料、生化指标、预后情况。分析高NLR/MLR组和低NLR/MLR组在不同治疗方案、不同临床特征患者之间的预后评估意义。以高NLR和高MLR作为2个危险因素设计风险分层,比较风险因素对MM患者预后的影响。结果:ROC曲线分析确定NLR最佳截断点为3.1(灵敏度为75%,特异性为70.7%),MLR最佳截断点为0.34(灵敏度为83.3%,特异性为53.4%)。MM患者乳酸脱氢酶(LDH)和血小板平均体积(MPV)水平与NLR和MLR有关(P<0.05)。两组患者在年龄、性别、血清钙(Ca)、血清β2微球蛋白(β2-MG)、白蛋白(Alb)、血红蛋白(Hb)、血小板(PLT)、血肌酐(Cr)、骨髓浆细胞比例及ISS分期上的差异均无统计学意义。高NLR组和高MLR组患者OS较低NLR组、低MLR组患者短,预后差(P<0.05)。进一步分析发现,在新型药物治疗组、传统化疗组、不同年龄分层组、不同β2-MG分层组和不同血肌酐分层组中,不同MLR、NLR分组患者的OS时间差异均有统计学意义。有2种危险因素的患者预后比0-1个危险因素的患者差。结论:初发MM患者NLR和MLR的升高与预后不良存在相关性,NLR和MLR可能是MM患者病情和预后评估的重要指标。

Value of Neutrophil/Lymphocyte Ratio and Monocyte/Lymphocyte Ratio in the Prognosis of Patients with Multiple Myeloma

Objective:To investigate the effect of neutrophil/lymphocyte ratio(NLR)and monocyte/lymphocyte ratio(MLR)in the valuation prognosis of patients with multiple myeloma(MM).Methods:The clinical data of 82 patients with initially diagnosed MM admitted to Gansu Provincial People's Hospital was analyzed retrospectively.NLR and MLR were calculated based on blood routine results respectively.The optimal cut-off point of NLR and MLR was determined according to the ROC curve,and the patients were divided into the high NLR/MLR group and the low NLR/MLR group.The general data,biochemical indicators and prognosis of the patients in each groups were compared respectively.The prognostic significance of the high NLR/MLR group and the low NLR/MLR group in patients between different treatment regimens and different clinical characteristics were analyzed.Risk stratification was designed based on NLR and high MLR as two risk factors,and the effect of risk factors,on the prognosis of MM patients were compared.Results:ROC curve analysis determined that the optimal cut-off point of NLR was 3.1(sensitivity 75%,specificity 70.7%)and the optimal cut-off point of MLR was 0.34(sensitivity 83.3%,specificity 53.4%).The lactate dehydrogenase(LDH)and mean platelet volume(MPV)were correlated to NLR and MLR(P<0.05).There were no significant difference in age,sex,serum calcium(Ca),β2-microglobulin(β2-MG),albumin(Alb),hemoglobin(Hb),platelet(PLT),serum creatinine(Cr),bone marrow plasma cell ratio and ISS stage between the two groups(P>0.05).The OS rate of patients with higher NLR and MLR was lower than those with low NLR and MLR and showed poor prognosis;Further analysis showed that there were statistically significant differences in OS time among patients with different MLR and NLR in the new drug treatment group and the traditional chemotherapy group,as well as patients in different age stratification groups,differentβ2-MG stratification groups and different serum creatinine stratification groups.Patients with 2 risk factors showed a poorer prognosis than those with 0-1 risk factor.Conclusion:Elevated NLR and MLR are associated with poor prognosis in MM patients and may serve as the cost-effective and readily available prognostic biomarkers.