多发性骨髓瘤合并侵袭性真菌感染患者外周血淋巴单核比淋巴细胞亚群变化及其与预后的关系

doi:10.3969/j.issn.1006-6233.2022.03.07

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摘要 目的:分析多发性骨髓瘤(MM)合并侵袭性真菌感染(IFI)患者外周血淋巴细胞与单核细胞比值(LMR)和淋巴细胞亚群[T淋巴细胞(CD3⁺)、B淋巴细胞(CD19⁺)、NK淋巴细胞(CD16⁺56⁺)]水平的变化及与预后的关系。方法:选择2016年1月至2018年3月我院收治的MM合并IFI患者105例作为研究对象作为观察组,选择MM未合并IFI的患者98例作为对照组。将观察组按照Durie-Salmon分期(DS分期)分为Ⅰ~Ⅱ期46例,Ⅲ期59例。使用流式细胞术检测各组LMR、CD3⁺、CD19⁺和CD16⁺56⁺水平。分析其在MM合并IFI患者中上述各参数水平及其与DS分期的关系,按照患者三年内的随访情况分为存活组和死亡组,分析不同预后患者上述指标的差异及并采用受试者工作特征曲线(ROC)分析上述参数对MM合并IFI患者DS分期的诊断价值和预后的预测价值。结果:①观察组患者外周血LMR和CD19⁺、CD16⁺56⁺较对照组均降低,且CD3⁺较对照组升高,具有统计学意义(P<0.05)。②DS分期Ⅲ期患者LMR和CD19⁺和CD16⁺56⁺均较Ⅰ~Ⅱ期降低,CD3⁺高于Ⅰ~Ⅱ期患者(P<0.05)。③外周血LMR、CD19⁺和CD16⁺56⁺水平与MM合并IFI患者DS分期呈负相关(rs=-0.686、-0.659、-0.661,P<0.01,CD3⁺与DS分期呈正相关(rs=0.551,P<0.05)。④外周血LMR、CD3⁺、CD19⁺和CD16⁺56⁺水平指导MM合并IFI患者DS分期Ⅰ~Ⅱ期与Ⅲ期均有较高效能,LMR≤6.14时诊断MM合并IFI患者DS分期为Ⅲ期的效能最高,敏感度和特异度分别为91.53%和89.13%。⑤死亡组外周血LMR、CD19⁺和CD16⁺56⁺水平均显著低于存活组,CD3⁺水平高于存活组,差异具有统计学意义(P<0.05);外周血LMR、CD3⁺、CD19⁺和CD16⁺56⁺水平指导MM合并IFI患者预后均有较高效能,LMR≤4.02时预测MM合并IFI患者不良预后的效能较高,其敏感度和特异度分别为79.56%和88.42%。结论:多发性骨髓瘤合并侵袭性真菌感染患者外周血LMR和CD19⁺和CD16⁺56⁺降低,CD3⁺升高,其与疾病进展及预后均存在关联,可以指导鉴别MM合并IFI患者的DS分期,可作为辅助评估MM合并IFI病情变化及预后的依据。

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关键词 ：多发性骨髓瘤, 侵袭性真菌感染, 淋巴细胞与单核细胞比值, 淋巴细胞亚群

Abstract：Objective: To analyze the changes in peripheral blood lymphomonocyte ratio (LMR) and lymphocyte subsets [T lymphocyte (CD3⁺), B lymphocyte (CD19⁺), NK lymphocyte (CD16⁺56⁺)] in patients with multiple myeloma (MM) complicated with invasive fungal infection (IFI) and their relationship with prognosis. Methods: A total of 105 patients with MM complicated with IFI treated in the hospital between January 2016 and March 2018 were selected as observation group, and another 98 patients with MM but without IFI were enrolled as control group. According to Durie-Salmon staging (DS staging), the patients in the observation group were divided into 46 cases in stage I-II and 59 cases in stage III. Flow cytometry was used to detect the levels of LMR, CD3⁺, CD19⁺ and CD16⁺56⁺ in each group. The levels of the above parameters in patients with MM and IFI and their relationship with DS staging was analyzed. According to the follow-up status within 3 years, the patients were classified into survival group and death group, and the differences in the above indicators of patients with different prognosis status were analyzed. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of the above parameters on DS staging of patients with MM and IFI and predictive value on prognosis. Results: ① The levels of peripheral blood LMR and CD19⁺ and CD16⁺56⁺ of observation group were reduced, while the CD3⁺ level was risen compared with those of control group (P<0.05). ② The levels of LMR, CD19⁺ and CD16⁺56⁺ of patients with DS stage III were lower than those of patients with stage I-II while the level of CD3⁺ was higher than that of patients with stage I-II (P<0.05). ③ Peripheral blood LMR, CD19⁺ and CD16⁺56⁺ levels were negatively correlated with DS staging of patients with MM complicated with IFI (rs=-0.686, -0.659, -0.661, P<0.01), and CD3⁺ was positively correlated with DS staging (rs=0.551, P<0.05). ④ Peripheral blood LMR, CD3⁺, CD19⁺ and CD16⁺56⁺ levels had higher efficiency in guiding the DS stages I-II and III in patients with MM and IFI. When LMR was ≤ 6.14, the diagnostic efficiency on DS stage III in patients with MM complicated with IFI was the highest, with sensitivity of 91.53% and specificity of 89.13% respectively. ⑤ The levels of peripheral blood LMR, CD19⁺ and CD16⁺56⁺ in death group were lower, while the level of CD3⁺ was higher than in survival group (P<0.05). Peripheral blood LMR, CD3⁺, CD19⁺ and CD16⁺56⁺ have high efficiency on guiding the prognosis of patients with MM complicated with IFI. When LMR was ≤ 4.02, the efficiency of predicting the poor prognosis of patients with MM and IFI was high with sensitivity of 79.56% and specificity of 88.42%. Conclusion: Peripheral blood LMR, CD19⁺ and CD16⁺56⁺ are decreased while CD3⁺ is increased in patients with multiple myeloma complicated with invasive fungal infection. In addition, the above indicators are related to disease progression and prognosis, and can guide the identification of DS staging of patients with MM complicated with IFI and can be used as an auxiliary basis to evaluate the disease condition changes and prognosis of MM with IFI.

Key words： Multiple myeloma Invasive fungal infection Lymphocyte-to-monocyte ratio Lymphocyte subsets

基金资助:2017年四川省卫生和计划生育委员会科研课题,(编号:17PJ594)

通讯作者: 代明辉

引用本文:

陈丽娟, 张家友, 韩少玲, 吴晶, 陈园园, 代明辉. 多发性骨髓瘤合并侵袭性真菌感染患者外周血淋巴单核比淋巴细胞亚群变化及其与预后的关系[J]. 河北医学, 2022, 28(3): 383-389.
CHEN Lijuan, ZHANG Jiayou, HAN Shaoling, et al. Changes in Peripheral Blood Lymphomonocyte Ratio and Lymphocyte Subsets and the Relationship with Prognosis in Patients with Multiple Myeloma Complicated with Invasive Fungal Infection. HeBei Med, 2022, 28(3): 383-389.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.03.07 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I3/383

[1] Liu J,Liu W,Mi L,et al.Union for China lymphoma investigators of the Chinese society of clinical oncology; union for China leukemia investigators of the Chinese society of clinical oncology.Incidence and mortality of multiple myeloma in China,2006-2016:an analysis of the global burden of disease study 2016[J].Hematol Oncol,2019,12(1):136.
[2] 廖中廷,李娟,兰霞,等.外周血淋巴细胞/单核细胞比值对接受新药治疗的多发性骨髓瘤预后价值的研究[J].中国医药导报,2020,17(23):82~85.
[3] 余延芳,高乃姝,王明迪,等.多发性骨髓瘤患者外周血淋巴细胞亚群动态变化的临床意义[J].中国肿瘤临床与康复,2021,28(6):660~663.
[4] 董立山,朱默,陈建华,等.全身磁共振类PET成像对Durie-Salmon Staging System价值的初步研究[J].医学影像学杂志,2017,27(1):135~139.
[5] 耿传营,陈文明.《中国多发性骨髓瘤诊治指南(2015年修订)》治疗部分解读[J].临床血液学杂志,2016,29(6):923~926.
[6] 中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第四次修订版)[J].中华内科杂志,2013,52(8):704~709.
[7] 褚娜利,张靖宇,郭丽,等.多发性骨髓瘤化疗后合并肺部感染患者呼吸及炎症指标水平分析[J].重庆医学,2021,50(8):1309~1313.
[8] Nakamura K,Smyth MJ,Martinet L.Cancer immunoediting and immune dysregulation in multiple myeloma[J].Blood,2020,136(24):2731~2740.
[9] 蒙沙,张杨,岳溪,等.多发性骨髓瘤患者外周血淋巴细胞计数单核细胞计数淋巴细胞与单核细胞比值与患者预后的关系[J].河北医学,2021,27(1):56~61.
[10] 袁茂林,韩琼,吴斌.外周血淋巴细胞和单核细胞比值与乳腺癌新辅助化疗疗效关联性[J].中华肿瘤防治杂志,2020,27(4):283~287.
[11] 桂前乐,汪延生,黄山,等.肿瘤相关性巨噬细胞在多发性骨髓瘤中的浸润及其临床意义[J].中华血液学杂志,2018,39(2):122~127.
[12] 袁中健,王龙,卢秀娟,等.miRNA和Th17相关细胞因子在多发性骨髓瘤患者发病中的作用[J].国际免疫学杂志,2019,42(6):583~587.
[13] 程盼盼,王翠玲,张向晖,等.淋巴单核比、淋巴细胞亚群在多发性骨髓瘤患者外周血的表达分析及与预后的关系[J].中国实验诊断学,2019,23(9):1499~1501.
[14] 王毅钧,李瑞平,李力波,等.CD68⁺肿瘤相关巨噬细胞在结直肠癌中的表达与预后的关系[J].广东医学,2019,40(7):994~997.
[15] Chen XQ,Xue CR,Hou P,et al.Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer[J].World Gastroenterol,2019,25(33):4970~4984.