血清IL-9、IL-17及IL-23水平对多发性骨髓瘤患者肾损伤的诊断价值

目的:探讨血清白细胞介素-9（IL-9）、白细胞介素-17（IL-17）及白细胞介素-23（IL-23）水平对多发性骨髓瘤（multiple myeloma,MM）患者肾损伤的诊断价值。方法:选取2015年01月至2019年12月我院收治的82例MM患者，依据国际分期系统（ISS）分为I期（n=16）、Ⅱ期（n=25）和Ⅲ期（n=41），根据肾功能情况，将其分为肾损伤组（n=27）和无肾损伤组（n=55）。另选取同期55例正常者作为对照组。检测各组血清IL-9、IL-17及IL-23水平。应用受试者工作特征（ROC）曲线分析血清IL-9、IL-17及IL-23水平诊断MM患者肾损伤的价值。采用Pearson相关分析MM患者血清IL-9、IL-17及IL-23水平之间的相关性。结果:MM组血清IL-9（66.72±18.50 vs 21.95±6.84，pg/mL）、IL-17（52.70±12.16 vs 24.36±5.73，pg/mL）及IL-23（81.60±22.75 vs 36.25±8.46，pg/mL）水平均明显高于对照组（P＜0.001）。随着ISS分期的增加，MM患者血清IL-9、IL-17及IL-23水平增加，Ⅲ期＞Ⅱ期＞Ⅰ期，差异有统计学意义（P＜0.001）。肾损伤组血清IL-9（93.60±24.65 vs 48.20±12.73，pg/mL）、IL-17（74.80±19.42 vs 35.26±8.50，pg/mL）及IL-23（116.48±40.25 vs 62.70±15.24，pg/mL）水平均明显高于无肾损伤组（P＜0.001）。ROC曲线分析显示，IL-9、IL-17及IL-23三项联合诊断MM患者发生肾损伤的曲线下面积（0.927，95%CI:0.865～0.983）最大，其灵敏度最高。相关分析显示，MM患者血清IL-9、IL-17及IL-23水平之间均呈正相关（P＜0.001）。结论:血清IL-9、IL-17、IL-23水平在MM中明显升高，且与MM患者的病情分期及肾损伤有关，三项联合诊断肾损伤的价值较高。

The diagnostic value of serum IL-9,IL-17 and IL-23 levels in renal injury of patients with multiple myeloma

Objective:To investigate the diagnostic value of serum interleukin-9(IL-9),interleukin-17(IL-17) and interleukin-23(IL-23) levels in the diagnosis of renal injury in patients with multiple myeloma(MM).Methods:The eighty-two MM patients admitted to our hospital from January 2015 to December 2019 were divided into phase I(n=16),phase Ⅱ(n=25) and phase Ⅲ(n=41) with the international staging system.According to renal function,MM patients were divided into renal injury group(n=27) and non renal injury group(n=55).Another 55 normal persons in the same period were selected as the control group.The levels of serum IL-9,IL-17 and IL-23 were detected in each group.Receiver operating characteristic(ROC) curve were used to analyze the value of serum IL-9,IL-17 and IL-23 levels in the diagnosis of renal injury in MM patients.Pearson correlation analysis was used to analyze the correlation between serum levels of IL-9,IL-17 and IL-23 in MM patients.Results:The levels of serum IL-9（66.72±18.50 vs 21.95±6.84，pg/mL）,IL-17（52.70±12.16 vs 24.36±5.73，pg/mL） and IL-23（81.60±22.75 vs 36.25±8.46，pg/mL） in MM group were significantly higher than those in control group(P＜0.001).With the increase of ISS stage,the levels of serum IL-9,IL-17 and IL-23 in MM patients were increased,phase Ⅲ ＞ phase Ⅲ ＞phase I,and the difference was statistically significant(P＜0.001).The levels of serum IL-9（93.60±24.65 vs 48.20±12.73，pg/mL）,IL-17（74.80±19.42 vs 35.26±8.50，pg/mL） and IL-23（116.48±40.25 vs 62.70±15.24，pg/mL） in renal injury group were significantly higher than those in non renal injury group(P＜0.001).ROC curve analysis showed that the area under the curve(0.927，95%CI:0.865-0.983) of IL-9,IL-17 and IL-23 combined diagnosis of renal injury in MM was the largest,and the sensitivity was the highest.Correlation analysis showed that the levels of serum IL-9,IL-17 and IL-23 were positively correlated(P＜0.001).Conclusion:The levels of serum IL-9,IL-17 and IL-23 are significantly increased in MM patients,which are related to the disease stage and renal injury of MM patients,and the value of three combined diagnosis of renal injury was higher.