控制营养状况评分和预后营养指数对自体造血干细胞移植治疗多发性骨髓瘤患者预后的影响

Effects of Control Nutritional Status and Prognostic Nutritional Index on Prognosis in Patients with Multiple Myeloma Treated by Autologous Hematopoietic Stem Cell Transplantation

摘要: 目的：探讨营养状况(CONUT)评分及预后营养指数(PNI)对行自体造血干细胞移植(ASCT)的多发性骨髓瘤(MM)患者预后的预测价值。方法：回顾性分析2017年1月至2023年12月青岛大学附属医院收治的98例诊断为MM并进行ASCT患者的一般资料、实验室指标、疾病分期等临床资料。根据受试者工作特征(ROC)曲线确定CONUT和PNI的最佳截断值并对患者进行分组，比较不同分组间的临床特征及早期疗效。采用Kaplan-Meier法绘制生存曲线，并对影响总生存(OS)的因素进行Cox回归单因素和多因素分析。结果：CONUT和PNI的最佳截断值分别为2.5和41.46。不同CONUT分组患者间初诊时外周血淋巴细胞差异有统计学意义(P < 0.05)。不同PNI分组的患者间初诊时血清钙离子、预处理前血清钙离子差异有统计学意义(P < 0.05)。不同分组的疗效分析显示，高CONUT组移植后3个月CR率及VGPR率均显著低于低CONUT组(P<0.05)，低PNI组移植后3个月VGPR率显著低于高PNI组(P < 0.05)。Kaplan-Meier生存曲线显示，低CONUT组OS和PFS均明显优于高CONUT组(中位OS：21个月vs 20个月，P < 0.001；中位PFS：18个月vs 15个月，P = 0.016)，低PNI组的OS较高PNI组明显缩短(中位OS：18个月vs 21个月，P < 0.01)。Cox比例风险回归模型分析显示，高CONUT是影响自体移植MM患者OS的独立危险因素(P < 0.05)。结论：CONUT评分和PNI在评估行ASCT治疗MM患者的预后方面具有一定应用价值；与PNI相比，CONUT评分对患者预后判断价值更大。

Abstract: Objective: To investigate the predictive value of the control nutritional status (CONUT) and prognostic nutritional index (PNI) for prognosis in patients with multiple myeloma treated by autologous hematopoietic stem cell transplantation. Methods: This study is a retrospective analysis of the clinical data of 98 patients diagnosed with Multiple Myeloma (MM) who underwent Autologous Stem Cell Transplantation (ASCT) at the Affiliated Hospital of Qingdao University between January 2017 and December 2023. The collected clinical data included general patient characteristics, laboratory indices, and disease staging. The optimal cutoff values for both CONUT and PNI were determined using Receiver Operating Characteristic (ROC) curve analysis to stratify patients into different groups. The clinical features and early efficacy were compared between these groups. Overall Survival (OS) curves were plotted using the Kaplan-Meier method. Both univariate and multivariate Cox regression analyses were performed to identify the factors influencing OS. Results: The optimal cutoff values for CONUT and PNI were determined to be 2.5 and 41.46, respectively. Statistically significant differences were noted between the CONUT-defined groups regarding peripheral blood lymphocyte count at initial diagnosis (P < 0.05). Furthermore, significant differences were observed between the PNI-defined groups for serum calcium levels at both initial diagnosis and pre-conditioning (P < 0.05). Efficacy analysis across groups revealed that the complete remission (CR) and very good partial response (VGPR) rates at 3 months post-transplantation were significantly lower in the high CONUT group compared to the low CONUT group (P < 0.05). Conversely, the low PNI group showed a significantly lower VGPR rate at 3 months post-transplantation than the high PNI group (P < 0.05). Kaplan-Meier survival analysis demonstrated that the low CONUT group had superior Overall Survival (OS) (median OS: 21 vs. 20 months, P < 0.001) and Progression-Free Survival (PFS) (median PFS: 18 vs. 15 months, P = 0.016) compared to the high CONUT group. The low PNI group exhibited a significantly shorter OS compared to the high PNI group (median OS: 18 vs. 21 months, P < 0.01). Cox regression analysis identified high CONUT score as independent risk factors for OS in ASCT-treated MM patients (P < 0.05). Conclusion: The CONUT score and PNI have certain application value in assessing the prognosis of multiple myeloma patients undergoing autologous stem cell transplantation. Compared with PNI, the CONUT score has greater value in predicting the prognosis of patients.