NRBC联合PLT检测对MM患者早期疗效 预测研究

Research on Predicting Early Treatment Efficacy in Patients with MM through Combined Detection of NRBC and PLT

摘要: 目的：探索外周血有核红细胞(NRBC)联合血小板(PLT)检测对初诊多发性骨髓瘤(MM)患者早期疗效的预测价值。方法：回顾性分析2020年5月至2023年5月115例初诊MM患者的临床资料，依据IMWG标准将患者分为化疗有效组(63例)和无效组(52例)，通过χ²/Mann-Whitney U检验进行组间比较，采用单因素及多因素Logistic回归分析筛选疗效的独立影响因素，通过ROC曲线及Delong检验评估NRBC、PLT单独及联合检测对疗效的预测效能，并进一步分析NRBC阳性亚组的疗效影响因素。结果：在患者组间基线资料无显著差异的情况下，化疗无效组相较于有效组，年龄更大、ECOG评分更高，DS、ISS、R-ISS分期更晚，NRBC阳性、PLT < 148 × 10⁹/L、合并高危遗传学异常占比更高，且Ig、UA、β₂-MG水平更高、Hb水平更低(均P < 0.05)。多因素Logistic回归分析得出，NRBC (OR: 3.958, P = 0.021)、PLT (OR: 10.536, P < 0.001)、年龄(OR: 1.083, P = 0.019)是影响MM患者早期疗效的独立危险因素。ROC曲线分析显示，NRBC、PLT单独检测预测疗效的AUC分别为0.729、0.724，二者联合检测的AUC达0.811，显著高于单一指标(均P < 0.05)。NRBC阳性亚组(53例)分析显示，化疗无效组年龄更大、NRBC水平更高、PLT和Hb水平更低(均P < 0.05)，多因素Logistic回归证实NRBC是该亚组疗效的独立危险因素(OR = 5.183, P = 0.015)。结论：初诊MM患者外周血NRBC联合PLT检测对早期疗效具有较高的预测价值，且NRBC阳性水平对疗效有分层预测作用，值得临床推广应用。

Abstract: Objective: To investigate the predictive value of combined detection of nucleated red blood cells (NRBC) and platelets (PLT) in peripheral blood for early treatment efficacy in newly diagnosed multiple myeloma (MM) patients. Methods: Clinical data of 115 newly diagnosed MM patients from May 2020 to May 2023 were retrospectively analyzed. According to the International Myeloma Working Group (IMWG) criteria, patients were categorized into a chemotherapy-responsive group (n = 63) and a chemotherapy-nonresponsive group (n = 52). Intergroup comparisons were performed using χ² or Mann-Whitney U tests. Univariate and multivariate logistic regression analyses were employed to identify independent factors influencing treatment efficacy. The predictive performance of NRBC and PLT, both individually and in combination, was assessed using receiver operating characteristic (ROC) curves and Delong’s test. Further analysis was conducted on efficacy-influencing factors within the NRBC-positive subgroup. Results: Baseline characteristics did not differ significantly between groups. Compared with the responsive group, the nonresponsive group had older age, higher Eastern Cooperative Oncology Group (ECOG) scores, more advanced Durie-Salmon (DS), International Staging System (ISS), and Revised-ISS (R-ISS) stages, a higher proportion of NRBC positivity, PLT < 148 × 10⁹/L, and combined high-risk genetic abnormalities, as well as higher immunoglobulin (Ig), uric acid (UA), and β₂-microglobulin (β₂-MG) levels, and lower hemoglobin (Hb) levels (all P < 0.05). Multivariate logistic regression indicated that NRBC > 0 (OR: 3.958, P = 0.021), PLT < 148 × 10⁹/L (OR: 10.536, P < 0.001), and age (OR: 1.083, P = 0.019) were independent risk factors affecting early treatment efficacy. ROC analysis revealed that the areas under the curve (AUC) for NRBC and PLT alone were 0.729 and 0.724, respectively, while the combined detection yielded an AUC of 0.811, which was significantly higher than that of each individual indicator (all P < 0.05). Analysis of the NRBC-positive subgroup (n = 53) showed that the nonresponsive group had older age, higher NRBC levels, and lower PLT and Hb levels (all P < 0.05). Multivariate logistic regression confirmed NRBC as an independent risk factor for treatment efficacy in this subgroup (OR = 5.183, P = 0.015). Conclusion: Combined detection of NRBC and PLT in peripheral blood demonstrates high predictive value for early treatment efficacy in newly diagnosed MM patients. NRBC positivity has a stratified predictive effect on treatment outcomes, warranting clinical promotion and application.