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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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

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

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