發(fā)布時(shí)間：2018-09-04 06:07

【摘要】：目的:探討外周血淋巴細(xì)胞絕對(duì)計(jì)數(shù)(absolute lymphocyte count,ALC)、單核細(xì)胞絕對(duì)計(jì)數(shù)(absolute monocyte count,AMC)和ALC/AMC比值(ALC/AMC ratio,LMR)在初治多發(fā)性骨髓瘤(multipe myeloma,MM)患者預(yù)后中的預(yù)測(cè)價(jià)值。方法:回顧性分析天津醫(yī)科大學(xué)腫瘤醫(yī)院2005年1月—2015年12月收治的190例初治MM患者,分析外周血ALC、AMC和LMR與外周血血紅蛋白(hemoglobin,Hb)、β_2-微球蛋白(β_2-microglobulin,β_2-MG)和乳酸脫氫酶(lactic dehydrogenase,LDH)以及骨髓漿細(xì)胞比例等臨床指標(biāo)之間的關(guān)系。通過(guò)受試者操作特征(receiver operating characteristic,ROC)曲線確定初治MM患者的ALC、AMC和LMR的界值。生存分析采用Kaplan-Meier法,log-rank檢驗(yàn)進(jìn)行預(yù)后的單因素分析,COX比例風(fēng)險(xiǎn)模型進(jìn)行預(yù)后的多因素分析。結(jié)果:通過(guò)ROC曲線確定ALC、AMC和LMR的界值分別為1.24×10~9/L、0.60×10~9/L和3.90,并以此為標(biāo)準(zhǔn)將患者分入高值組和低值組。多因素分析結(jié)果顯示,ALC1.24×10~9/L[風(fēng)險(xiǎn)比:0.544(95%可信區(qū)間:0.301~0.984),P=0.044)、LMR≤3.90[風(fēng)險(xiǎn)比:2.284(95%可信區(qū)間:1.018~5.124),P=0.045]和LDH247 U/L[風(fēng)險(xiǎn)比:1.972(95%可信區(qū)間:1.087~3.576),P=0.025]是初治MM患者獨(dú)立的預(yù)后不良因素。按每一例患者預(yù)后不良因素的數(shù)目(每一項(xiàng)獨(dú)立的預(yù)后不良因素記為1分),將患者分入0、1~2和3分組;3組患者的總生存和無(wú)進(jìn)展生存差異均有統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論:在初治MM患者中,外周血ALC和LMR值越低,提示患者的預(yù)后越差。外周血ALC值1.24×10~9/L和LMR≤3.90可能是初治MM患者獨(dú)立的不良預(yù)后因素。
[Abstract]:Objective: to investigate the prognostic value of absolute lymphocyte count (absolute lymphocyte count,ALC), monocyte absolute count (absolute monocyte count,AMC) and ALC/AMC ratio (ALC/AMC ratio,LMR) in patients with newly diagnosed multiple myeloma (multipe myeloma,MM). Methods: a retrospective analysis of 190 patients with primary MM admitted from January 2005 to December 2015 in Cancer Hospital of Tianjin Medical University was performed. The relationship between peripheral blood ALC,AMC and LMR, peripheral blood hemoglobin (hemoglobin,Hb), 尾 _ 2-microglobulin (尾 _ 2-MG), lactate dehydrogenase (lactic dehydrogenase,LDH) and ratio of bone marrow plasmacytes was analyzed. The threshold values of ALC,AMC and LMR in newly treated MM patients were determined by the (receiver operating characteristic,ROC curve. Survival analysis was performed with Kaplan-Meier 's log-rank test for univariate analysis of prognosis and Cox proportional risk model for multivariate analysis of prognosis. Results: ALC,AMC and LMR were determined as 1.24 脳 10 ~ (9) / L 0.60 脳 10 ~ (9) / L and 3.90 by ROC curve, respectively. The patients were divided into high value group and low value group. Multivariate analysis showed that ALC 1.24 脳 10 9 / L [risk ratio: 0. 544 (95% confidence interval: 0. 301 / 0. 84)] LMR 鈮，

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