中华保健医学杂志

目的 探讨分析中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)在多发性骨髓瘤患者预后评估中的应用价值。方法 回顾性研究连续纳入2017年1月～2022年12月华北理工大学附属医院收治的首次进行多发性骨髓瘤治疗的患者153例。整理患者一般资料及临床资料，将患者分为治疗前高NLR组、低NLR组，高MLR组和低MLR组及诱导后高NLR组、低NLR组，高MLR组和低MLR组，比较不同时点和组别的无进展生存期(PFS)及总体生存期(OS)。Cox回归分析患者预后的影响因素，通过绘制ROC曲线对治疗前后不同时点的NLR、MLR曲线下的面积(AUC)进行比较。结果 治疗前高NLR组中位PFS 19.2个月，低NLR组中位PFS 27.5个月，两组患者Kaplan-Meier生存曲线比较，差异有统计学意义(χ²=8.294,P=0.004);诱导治疗后高NLR组中位PFS 16.5个月，低NLR组中位PFS 29.3个月，两组患者Kaplan-Meier生存曲线比较，差异有统计学意义(χ²=15.599,P=0.000)。治疗前高MLR组中位PFS 20.1个月，低MLR组中位PFS 24.7个月，两组患者Kaplan-Meier生存曲线比较，差异有统计学意义(χ²=3.127,P=0.077);诱导治疗后高MLR组中位PFS 16.8个月，低MLR组中位PFS 25.2个月，两组患者Kaplan-Meier生存曲线比较，差异有统计学意义(χ²=5.409,P=0.020)。治疗前和治疗后不同NLR的OS生存曲线比较差异均有统计学意义(χ²=5.360、10.107,P<0.05)。治疗前和治疗后不同MLR的OS生存曲线比较差异均有统计学意义(χ²=3.868、4.667,P<0.05)。多因素Cox回归分析结果显示治疗前NLR为PFS和OS的影响因素；诱导治疗后NLR、MLR为PFS和OS的影响因素。诱导治疗4周期后NLR、MLR预测OS的AUC均大于治疗前，差异有统计学意义(P<0.05)。结论 对于多发性骨髓瘤患者诱导治疗后NLR、MLR对预后的预测价值优于初诊治疗前NLR、MLR。诱导治疗后NLR和MLR可作为危险度分层的有益补充。

Objective To compare the prognostic value of neutrophil-to-lymphocyte ratio(NLR)and monocyte-to-lymphocyte ratio(MLR)in multiple myeloma patients. Methods Patients with newly diagnosed multiple myeloma admitted to our department between January 2017 and December 2022 were consecutively enrolled. General and clinical data were collected. Patients were categorized into pre-treatment high-NLR group, low-NLR group, pre-treatment high-MLR group, low-MLR group, post-induction high-NLR group, low-NLR group, post-induction high-MLR group, and low-MLR group. Progression-free survival(PFS)and overall survival(OS)were compared across different time points and groups. Cox regression analysis was performed to identify prognostic factors, and receiver operating characteristic(ROC)curves were plotted to compare the area under the curve(AUC)of NLR and MLR at different time points. Results The pre-treatment high-NLR group had a median PFS of 19.2 months, while the low-NLR group had 27.5 months, with Kaplan-Meier survival curves showing a significant difference(χ²=8.294,P=0.004). After induction therapy, the high-NLR group had a median PFS of 16.5 months versus 29.3 months in the low-NLR group(χ²=15.599,P < 0.001). The pre-treatment high-MLR group showed a median PFS of 20.1 months compared to 24.7 months in the low-MLR group(χ²=3.127,P=0.077),while in post-induction, the high-MLR group had a median PFS of 16.8 months versus 25.2 months in the low-MLR group(χ²=5.409,P=0.020).Significant differences in OS were observed between NLR groups both pre-treatment(χ²=5.360,10.107,P < 0.05),as well as between MLR groups pre-treatment(χ²=3.868,4.667,P < 0.05). Multivariate Cox regression analysis using pre-treatment peripheral blood markers identified NLR as an independent prognostic factor for PFS and OS. Analysis using post-induction markers revealed both NLR and MLR as independent factors for PFS and OS. The AUC values of post-induction NLR and MLR for predicting OS were significantly greater than those before treatment, with statistically significant differences in AUC comparisons before and after therapy(P < 0.05). Conclusion For MM patients, NLR and MLR measured after induction therapy have superior predictive value for prognosis compared to those measured at initial diagnosis before treatment. Post-induction NLR and MLR can serve as a useful supplement for risk stratification.