2025 年第 9 期 第 20 卷

多发性骨髓瘤患者部分缓解时血清白细胞介素17及基质金属蛋白酶13与无进展生存期和总生存期的关系

Relationship between serum interleukin-17 and matrix metalloproteinase-13 and progression-free survival and overall survival in patients with multiple myeloma in partial remission

作者：冯素丽1赵艳梅2

英文作者：Feng Suli1 Zhao Yanmei2

单位：1浙江省人民医院杭州医学院附属人民医院血液科，杭州310014；2浙江省杭州市西溪医院血液科，杭州310014

英文单位：1Department of Hematology Zhejiang Provincial People′s Hospital People′s Hospital of Hangzhou Medical College Hangzhou 310014 China; 2Department of Hematology Hangzhou Xixi Hospital Zhejiang Province Hangzhou 310014 China

关键词：多发性骨髓瘤；部分缓解；白细胞介素17；基质金属蛋白酶13；无进展生存期；总生存期

英文关键词：Multiplemyeloma;Partialremission;Interleukin-17;Matrixmetalloproteinase-13;Progression-freesurvival;Overallsurvival

• 摘要：

• 目的 探讨多发性骨髓瘤患者部分缓解时血清白细胞介素17（IL-17）、基质金属蛋白酶13（MMP-13）与无进展生存期（PFS）和总生存期的关系。方法 选取2019年6月至2021年5月浙江省人民医院105例经临床治疗后达到部分缓解的多发性骨髓瘤患者作为研究对象。收集患者临床资料，检测血清IL-17、MMP-13水平。所有患者出院后均定期进行随访，统计生存情况、PFS和总生存期。使用受试者工作特征（ROC）曲线分析部分缓解时血清IL-17、MMP-13水平对患者预后的预测价值，并根据ROC曲线最佳截断值将患者分为高IL-17组和低IL-17组、高MMP-13组和低MMP-13组，比较组间PFS和总生存期。通过Cox回归分析模型对多发性骨髓瘤患者PFS和总生存期的影响因素进行分析。结果 截至随访结束，105例患者中77例存活、28例死亡，总生存率为73.3%（77/105），死亡率为26.7%（28/105）。ROC曲线分析结果显示，部分缓解时IL-17预测多发性骨髓瘤患者预后死亡的最佳截断值为30.85 ng/L，曲线下面积（AUC）=0.780，MMP-13预测的最佳截断值为10.68 ng/L，AUC=0.738。高IL-17组PFS、总生存期均短于低IL-17组［（19±4）个月比（29±5）个月、（36±6）个月比（50±6）个月］（t=12.000、11.545，均P<0.001）。高MMP-13组PFS、总生存期均短于低MMP-13组［（21±4）个月比（27±5）个月、（38±6）个月比（47±7）个月］（t=7.719、7.128，均P<0.001）。多因素Cox回归分析显示，乳酸脱氢酶、β2微球蛋白、IL-17、MMP-13、年龄、1q扩增、17p-是多发性骨髓瘤患者PFS的影响因素（均P<0.05）；β2微球蛋白、IL-17、MMP-13、年龄、1q扩增、17p-是患者总生存期的影响因素（均P<0.05）。结论 多发性骨髓瘤患者部分缓解时的血清IL-17、MMP-13水平与其PFS和总生存期有关，可作为中间阶段指标对患者预后进行评估。

• Objective To investigate the relationship between serum levels of interleukin-17 (IL-17) and matrix metalloproteinase-13 (MMP-13) and progression-free survival (PFS) and overall survival in patients with multiple myeloma in partial remission. Methods A total of 105 patients with multiple myeloma who achieved partial remission after clinical treatment in Zhejiang Provincial People′s Hospital from June 2019 to May 2021 were selected as the research objects. The clinical data of the patients were collected, and the serum levels of IL-17 and MMP-13 were detected. All patients were followed up regularly after discharge to calculate survival, PFS and overall survival. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum IL-17 and MMP-13 levels for the prognosis of patients with partial remission. According to the optimal cut-off value of ROC, the patients were divided into high IL-17 group and low IL-17 group, high MMP-13 group and low MMP-13 group. PFS and overall survival were compared between groups. Cox regression analysis model was used to analyze the influencing factors of PFS and overall survival in patients with multiple myeloma. Results At the end of the follow-up, 77 of 105 patients survived and 28 died, with an overall survival rate of 73.3% (77/105) and a mortality rate of 26.7% (28/105). ROC curve analysis showed that the best cut-off value of IL-17 to predict the prognosis of death in patients with multiple myeloma at partial remission was 30.85 ng/L, the area under the curve (AUC) =0.780, and the best cut-off value of MMP-13 to predict the prognosis of death in patients with multiple myeloma was 10.68 ng/L, AUC=0.738. The PFS and overall survival of the high IL-17 group were shorter than those of the low IL-17 group ［(19±4)months vs (29±5)months, (36±6)months vs (50±6)months］(t=12.000, 11.545, both P<0.001). The PFS and overall survival of the high MMP-13 group were shorter than those of the low MMP-13 group ［(21±4)months vs (27±5)months, (38±6)months vs (47±7)months］(t=7.719, 7.128, both P<0.001). Multivariate Cox regression analysis showed that lactate dehydrogenase, β2-microglobulin, IL-17, MMP-13, age, 1q amplification, and 17p- were the influencing factors of PFS in patients with multiple myeloma (all P<0.05).β2-microglobulin, IL-17, MMP-13, age, 1q amplification, and 17p- were the influencing factors of overall survival (all P<0.05). Conclusion The serum levels of IL-17 and MMP-13 in patients with multiple myeloma during partial remission are related to PFS and overall survival, which can be used as an intermediate stage indicator to evaluate the prognosis of patients.