[1]王 婷,张冰云,陈秀慧,等.多发性骨髓瘤患者化疗前后骨髓中巨噬细胞和噬血细胞变化及与临床预后价值的相关性[J].现代检验医学杂志,2025,40(03):150-157,163.[doi:10.3969/j.issn.1671-7414.2025.03.028]
　WANG Ting,ZHANG Bingyun,CHEN Xiuhui,et al.Changes of Macrophages and Hemophagocytes in Bone Marrow of Patients with Multiple Myeloma before and after Chemotherapy and Their Correlation with Clinical Prognostic Value[J].Journal of Modern Laboratory Medicine,2025,40(03):150-157,163.[doi:10.3969/j.issn.1671-7414.2025.03.028]
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多发性骨髓瘤患者化疗前后骨髓中巨噬细胞和噬血细胞变化及与临床预后价值的相关性()

《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年03期
页码:
150-157,163
栏目:
论著
出版日期:
2025-05-15

文章信息/Info

Title:
Changes of Macrophages and Hemophagocytes in Bone Marrow of Patients with Multiple Myeloma before and after Chemotherapy and Their Correlation with Clinical Prognostic Value
文章编号:
1671-7414（2025）03-150-09
作者:
王 婷a，张冰云a，陈秀慧a，许红月a，孙明丽a，刘英超b，张学勇a
（山东第一医科大学附属聊城市第二人民医院a. 血液科；b. 检验科，山东聊城 252600）
Author(s):
WANG Tinga，ZHANG Bingyuna，CHEN Xiuhuia，XU Hongyuea，SUN Minglia，LIU Yingchaob，ZHANG Xueyonga
(a. Department of Hematology ；b. Department of Clinical Laboratory，Liaocheng Second People’s Hospital Affiliated to Shandong First Medical University , Shandong Liaocheng 252600，China)
关键词:
多发性骨髓瘤; 巨噬细胞; 噬血细胞
分类号:
R733.3；R730.43
DOI:
10.3969/j.issn.1671-7414.2025.03.028
文献标志码:
A
摘要:
目的探究多发性骨髓瘤（MM）患者化疗前后骨髓中巨噬细胞和噬血细胞变化及与临床预后价值的相关性。方法选择2018年6月～2023年6月于山东第一医科大学附属聊城市第二人民医院就诊的MM患者300例为研究对象，所有患者均接受了至少3个疗程的化疗，根据临床疗效分为缓解组（n=214）和未缓解组（n=86）。检测两组IgA，IgG，CD3+，CD4+，CD8+，IL-2，IL-4，IL-6，IL-17，肿瘤坏死因子（TNF）-α，转化生长因子（TGF）-β，巨噬细胞和噬血细胞，并进行组间比较。COX回归分析各免疫指标与化疗不缓解的关系。限制性立方样条分析巨噬细胞和噬血细胞与化疗不缓解的关系。非条件Logistic回归模型分析巨噬细胞和噬血细胞对化疗不缓解的交互作用，交互作用计算表分析其相加交互作用。受试者工作特征（ROC）曲线分析巨噬细胞和噬血细胞单一或联合判断化疗不缓解的价值。结果MM患者化疗后总缓解率（ORR）为71.33%，不缓解率（NRR）为28.67%。与治疗前比较，治疗后两组患者IgA，IgG，CD8+，IL-6，IL-17，TNF-α，TGF-β，巨噬细胞和噬血细胞显著降低（t缓=9.252～61.177，t未缓=4.057～35.797）；CD3+，CD4+，CD4+/CD8+，IL-2和IL-4显著增加（t缓=9.706～33.940，t未缓=4.227～16.167），差异具有统计学意义（均P＜0.05）。治疗后未缓解组IgA，IgG，CD8+，IL-6，IL-17，TNF-α，TGF-β，巨噬细胞和噬血细胞显著高于缓解组（t=3.362～30.028），CD3+，CD4+，CD4+/CD8+，IL-2和IL-4显著低于缓解组（t=3.736～13.998），差异具有统计学意义（均P＜0.05）。COX回归调整其他因素的影响后，巨噬细胞和噬血细胞的趋势性检验差异仍具有统计学意义（均P＜0.05）。巨噬细胞≥5个/片和噬血细胞≥3个/片患者化疗不缓解风险显著增加（均P＜0.05）。巨噬细胞和噬血细胞在化疗不缓解中存在相加（OR=6.157，95%CI：3.768～12.978）及相乘（OR=5.648，95%CI：1.035～17.492）交互作用。相较于巨噬细胞和噬血细胞单一判断，两者联合判断化疗不缓解的准确度最高（P＜0.05）。结论MM患者化疗后巨噬细胞和噬血细胞较化疗前显著减少，巨噬细胞≥5个/片，噬血细胞≥3个/片，提示患者化疗不缓解风险显著增加，两者联合可准确判断临床疗效。
Abstract:
Objective To investigate the changes of macrophages and hemophagocytes in bone marrow smears of patients with multiple myeloma (MM) before and after chemotherapy and their correlation with clinical prognostic value. Methods A total of 300 MM patients treated in Liaocheng Second People’s Hospital Affiliated to Shandong First Medical University from June 2018 to June 2023 were selected as the study objects. All patients received at least 3 courses of chemotherapy and were divided into the remission group (n=214) and the non-remission group (n=86) according to the clinical effect. Immunoglobulin (Ig) A, IgG, CD3+, CD4+, CD8+, interleukin (IL-2), IL-4, IL-6, IL-17, tumor necrosis factor (TNF) -α, transforming growth factor (TGF) -β, macrophages and hemophagocytes were detected in the two groups and compared between the two groups. COX regression was used to analyze the relationship between immunological indexes and non-remission of chemotherapy. The relationship between macrophages and hemophagocytes and non-remission of chemotherapy was analyzed by restricted cubic spline. The multiplicative interaction of macrophages and hemophagocytes on non-remission of chemotherapy was analyzed using an unconditioned Logistic regression model, and the additive interaction was analyzed using the interaction calculation table. Receiver operating characteristic (ROC) curve analysis of macrophages and hemophagocytes alone or in combination to determine the value of chemotherapy non-remission. Results The overall response rate (ORR) and non-response rate (NRR) of MM patients were 71.33% and 28.67% respectively. Compared with before treatment, IgA, IgG, CD8+, IL-6, IL-17, TNF-α, TGF-β, macrophages and hemophagocytes were significantly decreased in both groups after treatment(tslow=9.252～61.177, tnot slow=4.057 ～ 35.797). CD3+, CD4+, CD4+/CD8+, IL-2 and IL-4 were significantly increased（tslow =9.706 ～ 33.940，tnot slow=4.227～16.167）， and the differences were statistically significant (all P<0.05). After treatment, compared with the remission group, IgA, IgG, CD8+, IL-6, IL-17, TNF-α, TGF-β, macrophages and hemophagocytes in the non-remission group were significantly higher than those in remission group（t=3.362 ～ 30.028）， CD3+, CD4+, CD4+/CD8+, IL-2 and IL-4 were significantly lower than those in remission group（t=3.736～13.998）. and the differences were statistically significant（all P＜0.05）. After adjusting the influence of other factors by COX regression, the trend test of macrophages and hemophagocytes was still statistically significant the trend test of macrophages and hemophagocytes was still statistically significant (P<0.05). Patients with≥5 macrophages/tablet and≥3 hemophagocytes/tablet had a significantly increased risk of non-remission from chemotherapy (P<0.05). There were additive (OR=6.157，95%CI: 3.768 ～ 12.978) and multiplicative (OR=5.648，95%CI:1.035～17.492) interactions between macrophages and hemophagocytes in the non-remission of chemotherapy. Compared with the single judgment of macrophages and hemophagocytes, the combination of the two has the highest accuracy in determining chemotherapy non-remission (P ＜ 0.05). Conclusion Macrophages and hemophagocytic cells in MM patients after chemotherapy are significantly lower than those before chemotherapy, with ≥5 macrophages/tablet and ≥3 hemocyte phages/tablet, indicating that the risk of non-remission in patients with chemotherapy increased significantly, and the combination of the two can accurately judge the clinical efficacy.

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备注/Memo

备注/Memo:
基金项目：山东省医药卫生科技发展计划项目（项目编号：202203040878）。
作者简介：王婷（1983-），女，硕士研究生，副主任医师，研究方向：浆细胞疾病的病生理及临床诊治，E-mail：wangtinglcey@163.com。
通讯作者：张学勇（1969-），男，本科，主任医师，研究方向：恶性病贫血，E-mail：Zhangxueyong@csco.ac.cn。
更新日期/Last Update: 2025-05-15