血清IFN-γ、MBL、sFas表达水平对多发性骨髓瘤患者预后的评估价值

doi:10.11958/20241655

天津医药 ›› 2025, Vol. 53 ›› Issue (2): 141-145.doi: 10.11958/20241655

血清IFN-γ、MBL、sFas表达水平对多发性骨髓瘤患者预后的评估价值

居峰¹(), 赵广玉¹, 刘银¹, 姜鑫², 印登阳¹, 顾红³^,^△()

1 扬州大学附属靖江人民医院临床药学科（邮编214500）
2 扬州大学附属靖江人民医院血液科（邮编214500）
3 扬州大学附属靖江人民医院药事管理科（邮编214500）

收稿日期:2024-10-15 修回日期:2024-12-16 出版日期:2025-02-15 发布日期:2025-02-26
通讯作者: ^△ E-mail：891021870@qq.com
作者简介:居峰（1985），女，副主任药师，主要从事抗肿瘤药物方面研究。E-mail：jls06mox@163.com
基金资助:
江苏省中医药科技发展计划项目(MS2022131)

The prognostic value of serum IFN-γ, MBL and sFas expression levels in patients with multiple myeloma

JU Feng¹(), ZHAO Guangyu¹, LIU Yin¹, JIANG Xin², YIN Dengyang¹, GU Hong³^,^△()

1 Department of Clinical Pharmacy, Jingjiang People's Hospital Affiliated to Yangzhou University, Jingjiang 214500, China
2 Department of Hematology, Jingjiang People's Hospital Affiliated to Yangzhou University, Jingjiang 214500, China
3 Department of Pharmaceutical Management, Jingjiang People's Hospital Affiliated to Yangzhou University, Jingjiang 214500, China

Received:2024-10-15 Revised:2024-12-16 Published:2025-02-15 Online:2025-02-26
Contact: ^△ E-mail：891021870@qq.com

居峰, 赵广玉, 刘银, 姜鑫, 印登阳, 顾红. 血清IFN-γ、MBL、sFas表达水平对多发性骨髓瘤患者预后的评估价值[J]. 天津医药, 2025, 53(2): 141-145.

JU Feng, ZHAO Guangyu, LIU Yin, JIANG Xin, YIN Dengyang, GU Hong. The prognostic value of serum IFN-γ, MBL and sFas expression levels in patients with multiple myeloma[J]. Tianjin Medical Journal, 2025, 53(2): 141-145.

摘要/Abstract

摘要：

目的探讨血清干扰素-γ（IFN-γ）、甘露糖结合外源凝集素（MBL）、可溶性Fas（sFas）表达水平对多发性骨髓瘤（MM）患者预后的评估价值。方法纳入150例确诊MM的患者，依照国际分期系统（ISS）标准将其分为Ⅰ期组46例、Ⅱ期组54例、Ⅲ期组50例。根据MM患者3年生存情况分为生存组98例和死亡组52例。采用酶联免疫吸附试验（ELISA）检测血清IFN-γ、MBL、sFas表达水平；Cox比例风险回归模型分析MM患者死亡的影响因素；受试者工作特征（ROC）曲线分析血清IFN-γ、MBL、sFas表达水平对MM患者死亡的预测价值。结果随着ISS分期的提高，患者血清Ca水平明显升高（P<0.05），IFN-γ表达水平显著降低，MBL、sFas水平显著升高（P<0.05）；死亡组患者血清IFN-γ水平与生存组相比显著降低，血清MBL、sFas水平显著升高（P<0.05）；死亡组患者ISS Ⅲ期人数占比、血清Ca水平显著高于生存组（P<0.05）；血清MBL、sFas、Ca水平升高，ISS分期为Ⅲ期是MM患者3年内死亡的危险因素，血清IFN-γ水平升高是保护因素（P<0.05）；血清IFN-γ、MBL、sFas联合诊断MM患者死亡的曲线下面积为0.977，优于单独诊断（Z分别为3.481、3.952、3.832，P<0.05）。结论 MM患者血清IFN-γ表达水平降低，MBL、sFas水平升高，与患者3年预后有关，三者联合对MM患者死亡具有预测价值，可以作为MM患者预后评估的生物标志物。

关键词: 多发性骨髓瘤, 甘露糖结合外源凝集素, 预后, 干扰素γ, 可溶性Fas

Abstract:

Objective To investigate the prognostic value of serum interferon-γ (IFN-γ), mannose-binding lectin (MBL) and soluble Fas (sFas) expression levels in patients with multiple myeloma (MM). Methods A total of 150 MM patients diagnosed in our hospital were included in this study and used as the research subjects. According to ISS staging, patients were separated into the stage Ⅰ group (46 cases), the stage Ⅱ group (54 cases) and the stage Ⅲ group (50 cases). According to the survival status of MM patients, they were assigned into the survival group (n=98) and the death group (n=52). Enzyme linked immunosorbent assay (ELISA) was applied to detect expression levels of serum IFN-γ, MBL and sFas. The influencing factors of prognostic mortality in MM patients were analyzed by Cox proportional hazard regression model. The receiver operating curve (ROC) was plotted to analyze the diagnostic value of serum IFN-γ, MBL and sFas expression levels in the prognostic mortality of MM patients. Results With the improvement of ISS stage, the serum Ca level of patients increased significantly (P<0.05). With the improvement of ISS staging, the expression level of serum IFN-γ was greatly decreased, while the levels of serum MBL and sFas were significantly increased (P<0.05). The serum IFN-γ level was significantly lower in the death group than that of the survival group, while the serum MBL and sFas levels were significantly higher (P<0.05). The proportion of ISS Ⅲ stage and the level of serum Ca were significantly higher in the death group than those in the survival group (P<0.05). Elevated serum levels of MBL, sFas and Ca and ISS stage Ⅲ were risk factors for death within three years in patients with MM, and elevated serum IFN-γ level was protective factor for death within three years in patients with MM (P<0.05). The AUC of prognostic mortality in patients with combined serum IFN-γ, MBL and sFas in the diagnosis of MM was 0.977, which was better than that of patients diagnosed alone (Z=3.481, 3.952 and 3.832, P<0.05). Conclusion The decreased serum IFN-γ expression and the increased MBL and sFas levels are related to the three-year prognosis of MM patients, and the combination of the three has predictive value for death of MM patients, and which can be used as a biomarker for the prognosis evaluation of MM patients.

Key words: multiple myeloma, mannose-binding lectin, prognosis, interferon-gamma, soluble Fas

中图分类号:

R733.3

图/表 7

参考文献 25

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组别		n	男/女	年龄/岁		BMI/（kg/m²）		高血压史		糖尿病史
Ⅰ期组		46	24/22	68.57±6.93		22.97±2.31		28（60.9）		26（56.5）
Ⅱ期组		54	31/23	69.21±7.06		23.43±2.38		31（57.4）		29（53.7）
Ⅲ期组		50	29/21	69.62±7.14		23.67±2.42		30（60.0）		23（46.0）
χ²或F			0.398	0.269		1.071		0.137		1.161
组别	基础方案/含来那度胺方案				Hb/（g/L）		IgM/（g/L）		Ca/（mmol/L）
Ⅰ期组	27/19				80.05±8.07		54.03±5.45		2.42±0.25
Ⅱ期组	28/26				81.02±8.15		54.89±5.51		2.94±0.31^a
Ⅲ期组	28/22				82.03±8.29		55.47±5.59		3.58±0.37^ab
χ²或F	0.484				0.704		0.823		163.373^＊＊

组别		n	男/女	年龄/岁		BMI/（kg/m²）		高血压史		糖尿病史
Ⅰ期组		46	24/22	68.57±6.93		22.97±2.31		28（60.9）		26（56.5）
Ⅱ期组		54	31/23	69.21±7.06		23.43±2.38		31（57.4）		29（53.7）
Ⅲ期组		50	29/21	69.62±7.14		23.67±2.42		30（60.0）		23（46.0）
χ²或F			0.398	0.269		1.071		0.137		1.161
组别	基础方案/含来那度胺方案				Hb/（g/L）		IgM/（g/L）		Ca/（mmol/L）
Ⅰ期组	27/19				80.05±8.07		54.03±5.45		2.42±0.25
Ⅱ期组	28/26				81.02±8.15		54.89±5.51		2.94±0.31^a
Ⅲ期组	28/22				82.03±8.29		55.47±5.59		3.58±0.37^ab
χ²或F	0.484				0.704		0.823		163.373^＊＊

组别	n	IFN-γ/（ng/L）	MBL/（mg/L）	sFas/（mg/L）
Ⅰ期组	46	32.85±3.31	14.03±1.42	6.51±0.68
Ⅱ期组	54	29.61±3.03^a	16.35±1.72^a	8.19±0.82^a
Ⅲ期组	50	26.94±2.72^ab	18.64±2.09^ab	9.64±1.07^ab
F		45.877^＊＊	81.115^＊＊	153.343^＊＊

组别	n	IFN-γ/（ng/L）	MBL/（mg/L）	sFas/（mg/L）
Ⅰ期组	46	32.85±3.31	14.03±1.42	6.51±0.68
Ⅱ期组	54	29.61±3.03^a	16.35±1.72^a	8.19±0.82^a
Ⅲ期组	50	26.94±2.72^ab	18.64±2.09^ab	9.64±1.07^ab
F		45.877^＊＊	81.115^＊＊	153.343^＊＊

组别	n	IFN-γ/（ng/L）	MBL/（mg/L）	sFas/（mg/L）
生存组	98	31.11±3.35	15.61±1.65	7.77±0.82
死亡组	52	27.08±2.76	17.89±1.96	8.89±0.97
t		7.435^＊＊	7.869^＊＊	7.464^＊＊

血清IFN-γ、MBL、sFas表达水平对多发性骨髓瘤患者预后的评估价值

The prognostic value of serum IFN-γ, MBL and sFas expression levels in patients with multiple myeloma

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组别		n	男/女	年龄/ 岁		BMI/ （kg/m²）		高血压史		糖尿病史
生存组		98	57/41	68.92±6.95		23.18±2.35		61（62.2）		49（50.0）
死亡组		52	27/25	69.58±7.01		23.72±2.41		28（53.9）		29（55.8）
χ²或t			0.537	0.551		1.305		0.993		0.453
组别	基础方案/含来那度胺方案				ISS分期（Ⅰ—Ⅱ期/Ⅲ期）		Hb/ （g/L）		IgM/ （g/L）		Ca/ （mmol/L）
生存组	52/46				82/16		81.91±8.23		54.41±5.52		2.76±0.28
死亡组	31/21				18/34		79.45±8.04		55.59±5.61		3.43±0.38
χ²或t	0.590				36.794^＊＊		1.757		1.239		12.283^＊＊

影响因素	B	SE	Wald χ²	P	HR	HR95%CI
IFN-γ	-0.529	0.157	11.367	<0.001	0.589	0.433~0.801
MBL	0.974	0.295	10.905	<0.001	2.649	1.486~4.723
sFas	1.032	0.276	13.984	<0.001	2.807	1.634~4.821
ISS分期Ⅲ期	1.105	0.307	12.946	<0.001	3.018	1.653~5.509
Ca	1.137	0.298	14.554	<0.001	3.117	1.738~5.590

指标	AUC	95%CI	截断值	敏感度/%	特异度/%	约登指数
IFN-γ	0.887	0.825~0.933	29.61 ng/L	96.15	70.41	0.666
MBL	0.865	0.800~0.915	17.07 mg/L	76.92	79.59	0.565
sFas	0.882	0.819~0.929	8.58 mg/L	78.85	88.78	0.676
联合	0.977	0.938~0.994	-	90.38	98.98	0.894

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