CAJ | 학술논문

目的：探讨造血干细胞移植合并症指数（HCT-CI）与查尔逊合并症指数（CCI）两种合并症评分系统对预测多发性骨髓瘤(MM)患者预后的判断价值。方法回顾性分析58例MM患者的临床资料。对MM患者的实验室指标进行单因素及Cox比例风险模型多因素分析，依据HCT-CI、CCI评分系统对患者合并症进行评分，采用ROC曲线检验比较不同分值对患者预后的影响。结果单因素分析显示血红蛋白（Hb）、血清肌酐、白蛋白、骨髓浆细胞比例、ISS分期、D-S分期、β2微球蛋白、乳酸脱氢酶（LDH）及合并症与预后相关（P＜0.05）。 Cox比例风险模型多因素分析显示有无合并症、β2微球蛋白、血肌酐、白蛋白是独立的预后危险因素。 HCT-CI、CCI和两者合并对MM患者预后预测的ROC曲线下面积[AUC (95%CI）]分别为0.719（0.512～0.827）、0.667（0.513～0.822）、0.743（0.664～0.918）。结论合并症是MM预后的独立危险因素，HCT-CI、CCI两种合并症评分系统可较好地评价预后。HCT-CI较CCI更能准确判读预后。重视并积极治疗合并症，可能有助于改善预后延长生存。
목적：탐토조혈간세포이식합병증지수（HCT-CI）여사이손합병증지수（CCI）량충합병증평분계통대예측다발성골수류(MM)환자예후적판단개치。방법회고성분석58례MM환자적림상자료。대MM환자적실험실지표진행단인소급Cox비례풍험모형다인소분석，의거HCT-CI、CCI평분계통대환자합병증진행평분，채용ROC곡선검험비교불동분치대환자예후적영향。결과단인소분석현시혈홍단백（Hb）、혈청기항、백단백、골수장세포비례、ISS분기、D-S분기、β2미구단백、유산탈경매（LDH）급합병증여예후상관（P＜0.05）。 Cox비례풍험모형다인소분석현시유무합병증、β2미구단백、혈기항、백단백시독립적예후위험인소。 HCT-CI、CCI화량자합병대MM환자예후예측적ROC곡선하면적[AUC (95%CI）]분별위0.719（0.512～0.827）、0.667（0.513～0.822）、0.743（0.664～0.918）。결론합병증시MM예후적독립위험인소，HCT-CI、CCI량충합병증평분계통가교호지평개예후。HCT-CI교CCI경능준학판독예후。중시병적겁치료합병증，가능유조우개선예후연장생존。
Objective To investigate the values of two comorbidity scoring systems, hematopoietic cell transplantation comorbidity index (HCT-CI) and Charlson’s comorbidity index (CCI),in prognosis prediction of multiple myeloma (MM).Methods The clinical data of 58 patients with MM were analyzed retrospectively. Laboratory indexes were analyzed using univariate analysis and multivariate Cox proportional hazards model. The comorbidity scores were measured according to HCT-CI and CCI scoring systems, and the effects of different scores on prognosis were evaluated using ROC curve analysis. Results Univariate analysis showed that hemoglobin, serum creatinine, albumin, proportion of plasma cells in bone marrow, ISS staging, D-S staging, β2-microglobulin, lactic dehydrogenase and complications were associated with the prognosis(P<0.05). Multivariate analysis by Cox regression model showed that the presence or absence of comorbidity, β2-microglobulin, serum creatinine and albumin were the independent prognostic risk factors. The AUC was 0.719(95% CI=0.512-0.827) for the HCT-CI, 0.667 (95%CI=0.513-0.822) for the CCI, and 0.743 (95% CI=0.664-0.918) for the combination of HCT-CI and CCI. Conclusion The comorbidity is an independent risk factor for the prognosis of MM.Both HCT-CI and CCI can be used to better evaluate the prognosis. The HCT-CI has a stronger predictive power than CCI. Paying an attention to aggressive therapy may contribute to the improvement of prognosis and prolongation of survival.