N-末端 B 型利钠肽前体（NT-proBNP）与多发性骨髓瘤的疾病严重程度相关。

N-terminal B-type natriuretic peptide (NT-proBNP) is associated with disease severity in multiple myeloma.

机构信息

Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.

Complexity-Research, FH Campus Vienna, Austria and TU Dortmund, Germany.

出版信息

Eur J Clin Invest. 2018 Apr;48(4). doi: 10.1111/eci.12905. Epub 2018 Feb 27.

DOI:10.1111/eci.12905

PMID:29417568

Abstract

BACKGROUND

Elevated levels of cardiovascular markers including N-terminal B-type natriuretic peptide (NT-proBNP) have been shown to be associated with disease severity and mortality in an unselected population of cancer patients without cardiac disease. The aim of this study was to investigate whether NT-proBNP levels are related to disease severity in multiple myeloma (MM) and to assess the natural course of NT-proBNP levels throughout disease progression.

MATERIALS AND METHODS

We retrospectively analysed a total of 118 patients with MM, who were followed up routinely. NT-proBNP, beta-2-microglobulin (B2M) and levels of plasma cell-derived light chains were measured at baseline and follow-up (FUP) visits. All-cause mortality was defined as primary study endpoint, and the correlation between NT-proBNP and disease severity reflected by B2M and the International Staging System (ISS) was assessed.

RESULTS

During a median FUP of 845 (IQR:683-978) days, 31 patients (26%) died. NT-proBNP showed a highly significant positive correlation with B2M at first presentation [r = .65, P < .001] and increased significantly with progressing MM disease stage [133.3 pg/mL (IQR:51.5-282.0) for ISS stage 1, 487.4 pg/mL (IQR:123.8-738.3) for ISS stage 2 and 969.1 pg/mL (IQR:472.8-3748.0) for ISS stage 3, P < .001 between all groups]. During FUP, NT-proBNP levels rose significantly alongside other MM disease severity markers for patients experiencing the primary outcome [356.6 pg/mL (IQR:142.9-782.3) vs 862.9 pg/mL (IQR:338.8-4215.0), P < .001], whereas no significant changes in laboratory parameters could be detected for survivors.

CONCLUSIONS

Elevated levels of the cardiovascular marker NT-proBNP are associated with disease severity in patients with MM.

摘要

背景

在无心脏病的癌症患者人群中，心血管标志物 N 末端 B 型利钠肽（NT-proBNP）水平升高与疾病严重程度和死亡率相关。本研究旨在探讨 NT-proBNP 水平与多发性骨髓瘤（MM）疾病严重程度的关系，并评估 NT-proBNP 水平在疾病进展过程中的自然变化。

材料和方法

我们回顾性分析了 118 例 MM 患者，这些患者接受了常规随访。在基线和随访（FUP）时，测量了 NT-proBNP、β-2 微球蛋白（B2M）和浆细胞衍生轻链水平。全因死亡率被定义为主要研究终点，并评估 NT-proBNP 与 B2M 和国际分期系统（ISS）反映的疾病严重程度之间的相关性。

结果

在中位数为 845 天（IQR：683-978）的 FUP 期间，31 例（26%）患者死亡。NT-proBNP 在初次就诊时与 B2M 呈显著正相关[r=0.65，P<0.001]，并随着 MM 疾病分期的进展而显著增加[ISS 分期 1 为 133.3 pg/mL（IQR：51.5-282.0），ISS 分期 2 为 487.4 pg/mL（IQR：123.8-738.3），ISS 分期 3 为 969.1 pg/mL（IQR：472.8-3748.0），所有组之间差异均有统计学意义（P<0.001）]。在 FUP 期间，发生主要结局的患者 NT-proBNP 水平与其他 MM 疾病严重程度标志物一起显著升高[356.6 pg/mL（IQR：142.9-782.3）比 862.9 pg/mL（IQR：338.8-4215.0），P<0.001]，而幸存者的实验室参数无显著变化。