中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值对三药联合方案初始治疗多发性骨髓瘤患者无进展生存时间的预测价值

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摘要目的探讨中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）在接受三药联合方案（RCD方案）的初治多发性骨髓瘤（MM）患者中预测无进展生存（PFS）的价值。方法选择2016年1月至2018年6月在宜春市人民医院住院的初诊MM患者70例为研究对象。所有患者接受RCD方案治疗，根据疗效将患者分为≥非常好的部分缓解（VGPR）组和＜VGPR组，比较两组的NLR、PLR差异；通过ROC曲线分析血清NLR、PLR对疗效的预测价值，计算AUC、灵敏度和特异度；采用Kaplan-Meier法构建MM患者的3年PFS生存曲线，log-rank检验进行生存曲线分析。对单因素分析中影响预后的相关因素进行多因素Cox回归分析。结果 ≥VGPR组的NLR、PLR低于＜VGPR组，差异有统计学意义（P＜0.05）；ROC曲线分析显示，NLR对治疗后疗效预测的AUC为0.802，灵敏度为70.5％，特异度为82.7％；PLR的AUC为0.794，灵敏度为66.7％，特异度为84.6％；NLR+PLR的AUC为0.843，灵敏度为61.5％，特异度为94.2％，联合检测的AUC、灵敏度、特异度最高。单因素分析结果显示，患者的β2微球蛋白、NLR、PLR是影响治疗后3年PFS的相关因素（P＜0.05），log-rank检验显示低NLR、PLR患者的3年PFS优于高NLR、PLR患者。多因素Cox回归分析显示，NLR＜2.55、PLR＜143.88均是MM患者治疗后3年内PFS的保护因素（P＜0.05）。结论 MM患者的NLR、PLR与疗效相关，较高的NLR、PLR预示着MM患者较短的无进展生存时间。联合应用NLR、PLR可更好地评估初诊MM患者的预后，对患者的临床治疗及疗效具有重要的指导意义。

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	巢玲
	谢璟
	徐烨
	邱小连

关键词 ：多发性骨髓瘤, 中性粒细胞/淋巴细胞比值, 血小板/淋巴细胞比值, 无进展生存时间

Abstract： Objective To explore the relationship between the efficacy and prognosis of neutrophil/lymphocyte ratio (NLR) and platelet / lymphocyte ratio (PLR) in progression-free survival (PFS) in patients with newly treated multiple myeloma (MM) who received three-drug regimen (RCD regimen). Methods Seventy newly diagnosed MM patients in Yichun People′s Hospital from January 2016 to June 2018 were selected as the research subjects. All patients were treated with RCD regimen. According to the efficacy, patients were divided into ≥ very good partial response (VGPR) group and < VGPR group, and the differences of NLR and PLR between the two groups were compared. The predictive value of serum NLR and PLR for curative effect was analyzed by ROC curve, and AUC, sensitivity and specificity were calculated. The 3-year PFS survival curve of MM patients was constructed by Kaplan-Meier method, and the survival curve was analyzed by log-rank test. Multivariate Cox regression analysis was performed on the factors affecting prognosis in univariate analysis. Results NLR and PLR in ≥VGPR group were lower than those in < VGPR group, and the differences were statistically significant (P<0.05). ROC curve analysis showed that the AUC, sensitivity and specificity of NLR for predicting post-treatment efficacy were 0.802, 70.5% and 82.7% respectively. The AUC of PLR was 0.794, the sensitivity was 66.7%, and the specificity was 84.6%. The AUC of NLR+PLR was 0.843, the sensitivity was 61.5%, and the specificity was 94.2%. The AUC, sensitivity and specificity of NLR+PLR were the highest. Univariate analysis showed that β2 microglobulin, NLR and PLR were the related factors affecting PFS 3 years after treatment (P<0.05). Log-rank test showed that the 3-year PFS of patients with low NLR and PLR was better than that of patients with high NLR and PLR. Multivariate Cox regression analysis showed that NLR <2.55 and PLR <143.88 were protective factors for PFS in MM patients within 3 years after treatment (P<0.05). Conclusion The NLR and PLR of MM patients are related to the curative effect. Higher NLR and PLR predicted shorter progression-free survival time in patients with MM. The combined application of NLR and PLR can better evaluate the prognosis of newly diagnosed MM patients, and has important guiding significance for the clinical treatment and curative effect of the patients.

Key words： Multiple myeloma Neutrophil-to-lymphocyte ratio Platelet-to-lymphocyte ratio Progression-free survival time

基金资助:江西省卫生健康委科技计划项目（202140868）

引用本文:

巢玲；谢璟；徐烨；邱小连. 中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值对三药联合方案初始治疗多发性骨髓瘤患者无进展生存时间的预测价值[J]. 中国当代医药, 2022, 29(20): 156-160.
CHAO Ling； XIE Jing； XU Ye； QIU Xiaolian. Prognostic value of neutrophil / lymphocyte ratio and platelet/lymphocyte ratio for progression-free survival in patients with multiple myeloma initially treated with a three-drug combination regimen. 中国当代医药, 2022, 29(20): 156-160.

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