Clin Lab. 2022 Apr 1;68(4). doi: 10.7754/Clin.Lab.2021.210716.
The goal of this study is to explore the clinical value of routine tests in multiple myeloma (MM).
A total of 179 MM patients, newly diagnosed in our hospital from January 2010 to December 2018 (case group), as well as 352 cases of healthy individuals (control group) were evaluated. Albumin (Alb), globulin (Glb), albumin/globulin (A/G), creatinine (Cr), calcium (Ca), hemoglobin (Hb), lactate dehydrogenase (LDH), platelet count (Plt), and platelet distribution width (PDW) were compared between the analyzed groups. Respective tests were screened by forward selection. Thereafter, screened out indicators were identified through logistic regression analysis. Risk prediction nomogram, area under curve (AUC), calibration, decision curve analysis (DCA), and clinical impact curve (CIC) were further performed. At the same time, routine test indicators of MM patients for stage and subtype diagnosis, were compared. A correlation analysis between these test indicators and respective disease stages was performed. High stage group and low stage groups were subsequently compared to define the predictive value of single and combined indicators of disease severity.
Except for Ca, the difference between the case and control groups for all other blood indicators was statistically significant (p < 0.05). Moreover, the difference in positive rate(s) was statistically significant (p < 0.05). The receiver operating characteristic (ROC) curve of Alb, Hb, and PDW harbored robust discrimination (AUC = 0.960) and appropriate calibration. The DCA and CIC showed that the resulting nomogram had a superior net benefit in predicting MM. Among all indicators, only LDH was statistically reduced in MM patients at ISS stages I, II, and III (p < 0.05). Interestingly, the ISS stage of respective MM patients was positively correlated with Cr (τ = 0.392), while it was negatively correlated with Hb (τ = -0.364). Alb, Glo, A/G, and Hb were significantly distinct between heavy chain (IgG, IgA) and LC, while few significant differences were found between the ISS stages. Lastly, the AUC (0.828) for Cr was greater than that for all other single and combined indicators.
The effective application of major indicators measured in routine blood tests can provide important clues for the diagnosis and prognosis of MM.
本研究旨在探讨多发性骨髓瘤（MM）常规检查的临床价值。
选取我院 2010 年 1 月至 2018 年 12 月新诊断的 179 例 MM 患者（病例组）和 352 例健康个体（对照组）进行评估。比较分析组间白蛋白（Alb）、球蛋白（Glb）、白蛋白/球蛋白（A/G）、肌酐（Cr）、钙（Ca）、血红蛋白（Hb）、乳酸脱氢酶（LDH）、血小板计数（Plt）和血小板分布宽度（PDW）。采用逐步向前选择法筛选各自的检测指标。然后，通过逻辑回归分析确定筛选出的指标。进一步进行风险预测列线图、曲线下面积（AUC）、校准、决策曲线分析（DCA）和临床影响曲线（CIC）。同时，比较 MM 患者常规检查指标对分期和亚型诊断的意义，并对这些检测指标与各自疾病分期进行相关性分析。随后，比较高分期组和低分期组，以确定疾病严重程度单一和联合指标的预测价值。
除 Ca 外，病例组与对照组所有其他血液指标的差异均有统计学意义（p < 0.05），且阳性率差异有统计学意义（p < 0.05）。Alb、Hb 和 PDW 的受试者工作特征（ROC）曲线具有良好的区分度（AUC = 0.960）和适当的校准。DCA 和 CIC 表明，生成的列线图在预测 MM 方面具有更好的净获益。在所有指标中，仅在 ISS 分期 I、II 和 III 期的 MM 患者中，LDH 有统计学意义的降低（p < 0.05）。有趣的是，MM 患者的 ISS 分期与 Cr 呈正相关（τ = 0.392），与 Hb 呈负相关（τ = -0.364）。重链（IgG、IgA）和轻链 MM 患者的 Alb、Glo、A/G 和 Hb 差异有统计学意义，而 ISS 分期之间差异无统计学意义。最后，Cr 的 AUC（0.828）大于所有其他单一和联合指标。
常规血液检测主要指标的有效应用可为 MM 的诊断和预后提供重要线索。
