【摘要】 目的 研究多发性骨髓瘤（MM）患者外周血中性粒细胞/淋巴细胞比值（NLR）、β₂微球蛋白（β₂-MG）、乳酸脱氢酶（LDH）与免疫表型、细胞遗传学以及预后生存之间的关系。方法 将该院2016年1月至2019年1月收治的233例MM患者（MM组）以及同期100例健康体检合格的志愿者（对照组）纳入研究。比较MM组和对照组以及不同DS分期的患者外周血NLR、血清β₂-MG以及LDH水平。以MM患者外周血NLR、β₂-MG以及LDH中位水平作为分组标准，将MM患者分别分为高、低NLR组，β₂-MG高、低水平组及LDH高、低水平组，比较不同亚组患者免疫表型、细胞遗传学以及预后生存状况。结果 MM患者外周血NLR及血清β₂-MG、LDH水平均高于对照组（P<0.05）。不同DS分期患者外周血NLR、血清β₂-MG、LDH水平：Ⅰ期<Ⅱ期<Ⅲ期，差异均有统计学意义（P<0.05）。MM组患者中，外周血NLR、血清β₂-MG、LDH的中位水平分别为1.96、3.94 mg/L、196.69 U/L,分别以此作为分界点划分亚组。高NLR组、β₂-MG高水平组以及LDH高水平组患者TP53、RB-1以及复杂核型检出率均分别高于低NLR组、β₂-MG低水平组以及LDH低水平组，差异均有统计学意义（P<0.05）。患者随访3年，绘制生存曲线发现，高NLR组、β₂-MG高水平组以及LDH高水平组的MM患者中位生存时间分别短于低NLR组、β₂-MG低水平组以及LDH低水平组，差异有统计学意义（Log-rank χ²=9.577、10.156、4.177,P<0.05）。结论 MM患者外周血NLR、β₂-MG以及LDH水平越高，其发生细胞遗传学及免疫表型异常的概率越大，生存时间也越短。外周血NLR、β₂-MG以及LDH水平在反映MM患者病情及预后中具有一定的价值。更多还原

【Abstract】 Objective To investigate the relationship between peripheral blood neutrophil-lymphocyte ratio（NLR）,β₂-microglobulin（β₂-MG） and lactate dehydrogenase（LDH） and immunophenotype, cytogenetics and prognostic survival in patients with multiple myeloma（MM）.Methods A total of 233 MM patients（MM group） admitted to the hospital from January 2016 to January 2019 and 100 healthy volunteers（control group） who underwent healthy examination during the same period were enrolled in the study.The peripheral blood NLR,serum β₂-MG and LDH were compared between the MM group and the control group and among patients with different DS stages.Using the median levels of NLR,β₂-MG and LDH in peripheral blood of MM patients as the grouping criteria, MM patients were divided into high-and low level NLR groups, and high-and low-level β₂-MG and LDH groups, respectively, and the immunophenotypes, cytogenetics, and prognostic survival of patients in different subgroups were compared.Results The peripheral blood NLR,serum β₂-MG and LDH levels of MM group patients were higher than those of the control group（P<0.05）.Peripheral blood NLR,serum β₂-MG and LDH levels in patients with different DS stages: stage Ⅰ<stage Ⅱ<stage Ⅲ,the difference was statistically significant（P<0.05）.In the MM group, the median levels of peripheral blood NLR,serum β₂-MG,and LDH were 1.96,3.94 mg/L,and 196.69 U/L,respectively, which were used as the cut-off values to divide the subgroups.The detection rates of TP53,RB-1 and complex karyotypes in the high-level NLR group, the high-level β₂-MG group and the high-level LDH group were higher than those in the low-level NLR group, the low-level β₂-MG group and the low-level LDH group, respectively, and the differences were all statistically significant（P<0.05）.After a 3-year follow-up, the survival curve was drawn, and it was found that the median survival time of MM patients in the high-level NLR group, the high-level β₂-MG group and the high-level LDH group was shorter than those in the low-level NLR group, the low-level β₂-MG group and the low-level LDH group, respectively, and with statistically significant differences in survival curves（Log-rank χ²=9.577,10.156,4.177,P<0.05）.Conclusion The higher the NLR and the levels of β₂-MG and LDH in MM patients, the greater the probability of cytogenetic and immunophenotypic abnormalities, and the shorter the survival time.Peripheral blood NLR,β₂-MG and LDH have certain value in reflecting the condition and prognosis of MM patients.更多还原