[1]任 梅,石培民,谢 静,等.血清CXCL9 和IL-34 水平检测对多发性骨髓瘤患者的疗效监测及其预后价值[J].现代检验医学杂志,2023,38(05):127-132.[doi:10.3969/j.issn.1671-7414.2023.05.024]
　REN Mei,SHI Peimin,XIE Jing,et al.Serum CXCL9 and IL-34 Levels in Multiple Myeloma Patients for Monitoring Efficacy and Prognostic Value[J].Journal of Modern Laboratory Medicine,2023,38(05):127-132.[doi:10.3969/j.issn.1671-7414.2023.05.024]
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血清CXCL9 和IL-34 水平检测对多发性骨髓瘤患者的疗效监测及其预后价值()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年05期
页码:
127-132
栏目:
论著
出版日期:
2023-09-15

文章信息/Info

Title:
Serum CXCL9 and IL-34 Levels in Multiple Myeloma Patients for Monitoring Efficacy and Prognostic Value
文章编号:
1671-7414（2023）05-127-06
作者:
任 梅; 石培民; 谢 静; 季 国; 李 娟; 叶春美; 许 荟
(泰兴市人民医院血液内科，安徽阜阳 236000)
Author(s):
REN Mei;  SHI Peimin;  XIE Jing;  JI Guo;  LI Juan;  YE Chunmei;  XU Hui
（Department of Hematology，Taixing People’s Hospital，Anhui Fuyang 236000，China）
关键词:
多发性骨髓瘤; C-X-C 基序趋化因子配体9; 白细胞介素-34
分类号:
R733.3；R730.43
DOI:
10.3969/j.issn.1671-7414.2023.05.024
文献标志码:
A
摘要:
目的 探讨C-X-C 基序趋化因子配体9（C-X-C motif chemokine ligand 9，CXCL9） 和白细胞介素-34（interleukin-34，IL-34）在多发性骨髓瘤（multiple myeloma，MM）患者血清中的表达及其诊断、疗效监测、预后诊断价值。方法 选取2017 年6 月～ 2019 年1 月在泰兴市人民医院进行治疗的MM 患者101 例为研究组，另纳入进行健康体检的志愿者95 例为对照组。采用酶联免疫法检测CXCL9 和IL-34 水平；利用受试者工作特征（receiver operatingcharacteristic，ROC）曲线评价血清CXCL9 和IL-34 水平对MM 的诊断价值；利用Kaplan-Meier 法分析MM 患者血清中CXCL9 和IL-34 表达与患者生存时间的关系；采用多因素COX 回归风险模型分析影响MM 患者预后的因素。结果 与对照组比较，MM 患者血清中CXCL9（950.56±180.11 pg/ml vs 273.03±50.19 pg/ml）和IL-34（15.53±4.26 pg/ml vs 3.05±0.81 pg/ml）表达水平升高，差异具有统计学意义（t=35.391，28.077，均P<0.05）；与化疗前比较，治疗获益组化疗后患者血清CXCL9（341.21±44.76 pg/ml vs 923.21±175.78 pg/ml）和IL-34 表达水平（4.21±0.59 pg/mlvs 14.96±4.10 pg/ml）下降，差异具有统计学意义（t=44.746， 32.924，均P<0.05）；治疗未获益组化疗后患者血清CXCL9（774.83±169.45 pg/ml vs 999.95±187.93 pg/ml）和IL-34 表达水平（12.17±3.65 pg/ml vs16.57±4.55 pg/ml）下降，差异具有统计学意义（t=13.692，11.365，均P<0.05）；与治疗未获益组相比，治疗获益组患者化疗后血清中CXCL9，IL-34 表达水平均较低（t=19.508，17.247，均P ＜ 0.05）；MM 患者血清中CXCL9 和IL-34 表达与D-S 分期、ISS，R-ISS，乳酸脱氢酶（lactate dehydrogenase，LDH）、清蛋白和血钙有关（t=3.029 ～ 7.219，均P<0.05）；ROC 结果显示，CXCL9 和IL-34 诊断MM 患者的曲线下面积（area under curve，AUC）分别为0.841，0.869；对应的敏感度分别为92.08%，84.16%；特异度分别为83.16%，91.58%。二者联合诊断MM 患者的AUC 为0.915，对应的敏感度和特异度分别为94.06%，74.74%；Kaplan-Meier 分析结果显示，CXCL9 低表达组患者三年累积生存率81.40%（35/43）显著高于高表达组的58.62%（34/58），差异有统计学意义（Log rank χ2=6.580，P=0.010）。IL-34 低表达组患者三年累积生存率79.17%（38/48）显著高于高表达组的58.49%（31/53），差异有统计学意义（Log rank χ2=5.658，P=0.017）；多因素COX 风险回归模型分析结果显示，CXCL9，IL-34, β2- 微球蛋白、血钙、血肌酐和LDH 均为影响MM 患者预后的独立危险因素（P<0.05）。结论 MM 患者血清中CXCL9 和IL-34 均呈高表达，二者表达对MM 患者的疗效监测、诊断及预后评估具有较高的辅助价值。
Abstract:
Objective To investigate the expression of C-X-C motif chemokine ligand 9 (CXCL9) and interleukin-34 (IL-34) in the serum of patients with multiple myeloma (MM) and their diagnostic value in diagnosis, efficacy monitoring and prognosis. Methods A total of 101 patients with MM who were treated in Taixing People’s Hospital from June 2017 to January 2019 were selected as the study group, and 95 volunteers for physical examination were selected as the control group. The levels of CXCL9 and IL-34 were detected by ELISA，the diagnostic value of CXCL9 and IL-34 in serum for MM was evaluated by ROC curve. Kaplan-Meier method was used to analyze the relationship between the expression of CXCL9, IL-34 and the survival time of MM patients. Multivariate COX regression risk model was applied to analyze the factors affecting the prognosis of MM patients. Results Compared with the control group, the serum levels of CXCL9 (950.56±180.11 pg/ml vs 273.03±50.19 pg/ml) and IL- 34 (15.53±4.26 pg/ml vs 3.05±0.81 pg/ml) in MM patients were increased, the difference was statistically significant (t=35.391，28.077, all P<0.05). Compared with before chemotherapy, serum CXCL9 (341.21±44.76 pg/ml vs 923.21±175.78 pg/ml) and IL-34 expression levels (4.21±0.59 pg/ml vs 14.96±4.10 pg/ml) decreased in patients in the treatment-benefited group after chemotherapy, with statistically significant differences (t=44.746，32.924,all P<0.05), and serum CXCL9 (774.83±169.45pg/ml vs 999.95±187.93pg/ml) and IL-34 expression levels (12.17±3.65pg/ml vs 16.57±4.55pg/ml) decreased in patients in the treatment-naive group after chemotherapy, with statistically significant difference (t=13.692，11.365, all P<0.05). Serum expression levels of CXCL9 and IL-34 were lower in patients in the treatment-benefit group after chemotherapy compared to the treatment-naive group (t=19.508，17.247, all P<0.05). The expression of CXCL9 and IL-34 in serum of MM patients was related to D-S stage，ISS，R-ISS，lactate dehydrogenase (LDH)， serum albumin and serum calcium (t=3.029 ～ 7.219, all P<0.05). ROC results showed that the area under curve (AUC) of CXCL9 and IL-34 in diagnosing MM patients was 0.841 and 0.869 respectively, with corresponding sensitivity of 92.08% and 84.16%, specificity of 83.16% and 91.58%, respectively. The AUC of MM patients diagnosed by the two methods was 0.915, the corresponding sensitivity and specificity was 94.06% and 74.74%, respectively. Kaplan-Meier analysis showed that the 3-year cumulative survival rate of patients with low CXCL9 expression was 81.40% (35/43), which was greatly higher than 58.62% (34/58) of patients with high CXCL9 expression (Log rank χ2=6.580, P=0.010). The 3-year cumulative survival rate of patients with low IL-34 expression was 79.17% (38/48), which was greatly higher than that of patients with high IL-34 expression 58.49% (31/53) (Log rank χ2=5.658, P=0.017). The analysis result of multifactor COX risk regression model showed that CXCL9, IL-34, β2-microglobulin, serum calcium, serum creatinine and LDH were independent risk factors affecting the prognosis of MM patients (P<0.05).Conclusion CXCL9 and IL-34 were highly expressed in the serum of patients with MM. The expression of CXCL9 and IL-34 has a high auxiliary value for efficacy monitoring, diagnosis and prognosis evaluation of MM patients.

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备注/Memo

备注/Memo:
基金项目：泰兴市人民医院资助项目（编号：try1914）：铁代谢相关指标在缺铁性贫血及慢性贫血诊断中的应用价值。
作者简介：任梅(1991-)，女，硕士研究生，主治医师，研究方向：血液内科，E-mail：f5g4t0@sina.com。
通讯作者：石培民，E-mail：chuanglinluo8@163.com。
更新日期/Last Update: 2023-09-15