作　　者： (李涵）; (李倩）; (曹增）; (刘素）; (马静）; (岳园芳）; (陈琳）; (颜廷辉）; (高爽）; (王雪）; (李东英）; (于泳）; (王晓芳）; (赵智刚）; (张翼鷟）; (王亚非）;

机构地区： 天津医科大学肿瘤医院血液科、国家肿瘤临床医学研究中心、天津市肿瘤防治重点实验室、天津市恶性肿瘤临床医学研究中心,天津300060

出　　处： 《肿瘤》 2017年第8期865-872,共8页

摘　　要： 目的:探讨外周血淋巴细胞绝对计数(absolute lymphocyte count,ALC)、单核细胞绝对计数(absolute monocyte count,AMC)和ALC/AMC比值(ALC/AMC ratio,LMR)在初治多发性骨髓瘤(multipe myeloma,MM)患者预后中的预测价值。方法:回顾性分析天津医科大学肿瘤医院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与外周血血红蛋白(hemoglobin,Hb)、β_2-微球蛋白(β_2-microglobulin,β_2-MG)和乳酸脱氢酶(lactic dehydrogenase,LDH)以及骨髓浆细胞比例等临床指标之间的关系。通过受试者操作特征(receiver operating characteristic,ROC)曲线确定初治MM患者的ALC、AMC和LMR的界值。生存分析采用Kaplan-Meier法,log-rank检验进行预后的单因素分析,COX比例风险模型进行预后的多因素分析。结果:通过ROC曲线确定ALC、AMC和LMR的界值分别为1.24×10~9/L、0.60×10~9/L和3.90,并以此为标准将患者分入高值组和低值组。多因素分析结果显示,ALC<1.24×10~9/L[风险比:0.544(95%可信区间:0.301~0.984),P=0.044)、LMR≤3.90[风险比:2.284(95%可信区间:1.018~5.124),P=0.045]和LDH>247 U/L[风险比:1.972(95%可信区间:1.087~3.576),P=0.025]是初治MM患者独立的预后不良因素。按每一例患者预后不良因素的数目(每一项独立的预后不良因素记为1分),将患者分入0、1~2和3分组;3组患者的总生存和无进展生存差异均有统计学意义(P值均<0.05)。结论:在初治MM患者中,外周血ALC和LMR值越低,提示患者的预后越差。外周血ALC值<1.24×10~9/L和LMR≤3.90可能是初治MM患者独立的不良预后因素。 Objective： To investigate the value of peripheral blood absolute lymphocyte count （ALC）, absolute monocyte count （AMC） and ALC/ AMC ratio （LMR） in predicting the prognosis of patients with newly diagnosed multiple myeloma （MM）.Methods： Retrospective analysis was performed in 190 patients with newly diagnosed MM from Tianjin Medical University Cancer Institute and Hospital between January 2005 and December 201 5. The relationships of peripheral blood ALC, AMC and LMR with peripheral blood hemoglobin （Hb）, β2-microglobulin （β2-MG） and lactate dehydrogenase （LDH） and the proportion of bone marrow plasma cells were analyzed. The cutoff values of ALC, AMC and LMR were determined by the receiver operating characteristic （ROC） curve in patients with newly diagnosed MM. Survival analysis was performed using Kaplan-Meier method and the log-rank test for univariate analysis of prognosis, and a COX proportional hazard model was used for multivariate analysis of prognosis. Results： The cutoff values of ALC, AMC and LMR determined by ROC curve were 1.24×10^9/L, 0.60×10^9/L and 3.90, respectively. According to these cutoff values, the patients were divided into high value groups and low value groups. The results of multivariate analysis showed that ALC 〈 1.24×10^9/L [hazard ratio （HR）： 0.544, 95% confidence interval （CI）： 0.301-0.984）; P = 0.044], LMR≤3.90 （HR： 2.284, 95% CI： 1.018-5.124; P = 0.045） and LDH 〉 247 U/L （HR： 1.972, 95% CI： 1.087-3.576; P = 0.025） were independent poor prognostic factors in untreated MM patients. According to the number of poor prognostic factors （each poor prognostic factor was scored as one）, the patients were divided into score 0, 1-2 and 3 groups, the overall survival and progression-free survival of the three groups were significantly different （all P 〈 0.05）.Conclusion： Lower ALC and LMR values may indicate poor prognosis. ALC〈1.24×10^9/L and LMC≤3.90 maybe the independent poor prognostic factors

关 键 词： 多发性骨髓瘤 外周血淋巴细胞计数 外周血单核细胞计数 外周血淋巴细胞计数与单核细胞计数之比 预后分析