血清高同型半胱氨酸在多发性骨髓瘤治疗及预后中的临床意义

摘要

Objective To analyze the clinical significance of serum homocysteine (Hcy) levels in the treatment and prognosis of multiple myeloma.Methods A total of 126 patients with multiple myeloma were included as treatment group,and 60 healthy subjects for physical examination in our hospital were included as control group.The differences of β2-microglobulin (β2-MG),hemoglobin (Hb),erythrocyte sedimentation rate (ESR),lactate dehydrogenase (LDH) and Hcy levels between treatment group and control group were analyzed.The treatment group were divided into Ⅰ,Ⅱ,Ⅲ stage groups according to pathological sta ges.The difference of β2-MG,Hb,ESR,LDH and Hcy levels in three groups was analyzed.The correlation between serum Hcy levels and β2-MG,Hb,ESR,LDH levels before treatment was analyzed by Pearson.The median survival of different Hcy levels in treatment group were analyzed.The effect of serum Hcy in the treatment and prognosis of patients with multiple myeloma was analyzed.Results The levels of serum β2-MG,ESR,LDH,Hcy and Hb in treatment group were (5.88±1.08)g · L-1,(79.84±9.67)mm· h-1,(323.59 ±23.57)U · L-1,(22.28 ± 3.76) μmol · L-1,(90.78 ± 10.15) g · L-1,had significant difference with those in control group,which were (2.87 ± 0.71) g · L-1,(18.92 ±3.64)mm · h-1,(156.82 ±19.83)U · L-1,(11.01 ±3.18) μmol · L-1,(141.62 ±15.27)g · L-1(all P ＜ 0.05).The levels of serum β2-MG,ESR,LDH,Hcy and Hb levels in stage Ⅱ and Ⅲ had significant difference with those in stage Ⅰ (P ＜ 0.05).The levels of serum β2-MG,ESR,LDH,Hcy and Hb in stage Ⅲ had significant difference with those in stage Ⅱ (P ＜ 0.05).Serum Hcy levels were positively correlated with the levels of β2-MG,ESR and LDH and negatively correlated with Hb (P ＜ 0.05).The median survival times in Hcy ≥ 22 μmol · L-1 and Hcy ＜ 22 μmol · L-1 groups were 31,38 months,with significant difference (P ＜ 0.05).Conclusion The serum levels of Hcy in patients with multiple myeloma were significantly higher,and the level of Hcy has a certain reference significance for the evaluation of therapeutic effect,and affects the prognosis of patients.%目的 分析血清高同型半胱氨酸(Hcy)在多发性骨髓瘤治疗及预后中的临床意义.方法 入选126例多发性骨髓瘤患者为试验组,同期60例于我院体检的健康者作为对照组,分析组间β2微球蛋白(β2-MG)、血红蛋白(Hb)、红细胞沉降率(ESR)、乳酸脱氢酶(LDH)和Hcy水平差别.根据病理分期,试验组分成Ⅰ、Ⅱ、Ⅲ期组,分析组间β2-MG、Hb、ESR、LDH和Hcy水平差异,并对治疗前血清Hcy水平和β2-MG、Hb、ESR、LDH水平进行Pearson相关性分析;对试验组中不同Hcy水平的2组患者中位生存期进行分析,分析血清Hcy对多发性骨髓瘤患者治疗和预后中的影响.结果 试验组血清β2-MG水平、ESR、LDH、Hcy和Hb水平分别为(5.88±1.08)g·L-1,(79.84±9.67) mm·h-1,(323.59±23.57)U· L-1,(22.28±3.76) μmol· L-1,(90.78±10.15)g· L-1;对照组分别为(2.87±0.71)g·L-1,(18.92±3.64)mm·h-1,(156.82±19.83)U·L-1,(11.01±3.18)μmol·L-1,(141.62±15.27)g ·L-1,差异均有统计学意义(均P＜0.05).Ⅱ期和Ⅲ期血清β2-MG水平、ESR、LDH、Hcy和Hb水平与Ⅰ期相比,差异均有统计学意义(均P ＜0.05),Ⅲ期血清β2-MG水平、ESR、LDH、Hcy和Hb水平与Ⅱ期相比,差异均有统计学意义(均P＜0.05).治疗前血清Hcy水平分别与β2-MG、ESR、LDH呈正相关(P＜0.05),与Hb呈现负相关(P＜0.05).Hcy≥22 μmol·L-1组中位生存期为31个月,Hcy＜22μmol·L-1组中位生存期为38个月,差异有统计学意义(P＜0.05).结论 多发性骨髓瘤患者血清Hcy水平明显升高,Hcy水平对治疗效果的评判有一定的参考意义,且影响患者预后.