多發性骨髓瘤患者血清胱抑素C水平測定_《華西醫學》

作者：

肖蓉

四川省醫學科學院·四川省人民醫院血液科（成都，610072）;

關鍵詞：

多發性骨髓瘤血清胱抑素C 腎功能損害腫瘤負荷溶骨性損害

DOI：

CNKI: 51-1356/R.20120214.1338.002

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目的　測定多發性骨髓瘤（MM）患者血清胱抑素C （Cys-C）的水平，探討Cys-C與國際分期體系（ISS）、血β2-微球蛋白、溶骨性損害等指標的關系。方法　收集2008年1月－2010年9月32例初治和8例復發的MM患者作為研究對象，同時收集40例健康體檢者的檢查資料作為對照組，測定血清Cys-C、血肌酐（Scr）、血β2-微球蛋白。采用核素全身骨顯像（ECT）觀察患者的溶骨性病變部位數。結果　患者血清Cys-C水平（1.40 mg/L）明顯高于健康對照組（0.90 mg/L）（P＜0.01）；在MM患者中Cys-C比Scr更敏感，能反映腎小球濾過率；血清Cys-C水平與ISS分期晚，血β2-微球蛋白升高以及溶骨性病變進展密切相關。結論　 MM患者的Cys-C水平高于健康者。Cys-C是骨髓瘤腎損害的早期敏感標志物，與腫瘤負荷及溶骨性損害密切相關，可作為評價腫瘤負荷的潛在指標。
Objective To evaluate the serum levels of cystatin-C in patients with multiple myeloma (MM), and to explore its possible correlations with clinical data, including ISS stage, serum β2-microglobulin, and advanced lytic lesions. Methods 　From January 2008 to September 2010, serum cystatin-C, creatinine (Scr), and β2-microglobulin in 32 patients with MM, 8 patients with relapsed disease, and in 40 healthy controls were detected by automatic biochemistry analyzer detection. According to skeleton ECT, grading of osteolytic lesion was observed. Results 　The levels of serum cystatin-C of patients with MM were significantly higher than those of the controls. Serum cystatin-C could reflect the glomerular filtration rate , and was more sensitive than Scr in patients with renal lesion. Serum cystatin-C had ber correlations with advanced ISS stages, high levels of serum β2-microglobulin, and extensive bone diseases. Conclusion 　Serum cystatin-C is a sensitive marker of renal lesion in patients with MM, it could be a potential indicator to assess the tumor burden.

引用本文： 肖蓉. 多發性骨髓瘤患者血清胱抑素C水平測定. 華西醫學, 2012, 27(2): 171-173. doi: CNKI: 51-1356/R.20120214.1338.002 復制

1.	Abbott KC, Agodoal LY. Multiple myeloma and light chain associated nephropathy at end-stage renal disease in the United States: patient characteristics and survival[J]. Clin Nephrol, 2001, 56(3): 207 -210.
2.	Lamb EJ, Stowe HJ, Simpson DE, et al. Diagnostic accuracy of cystatin C as a marker of kidney disease in patients with multiple myeloma: calculated glomerular filtration rate formulas are equally useful[J]. Clin Chem, 2004, 50(10): 1848-1851.
3.	Heidtmann HH, Salge U, Abrahamson M, et al. Cathepsin B and cysteine proteinase inhibitors in human lung cancer cell lines[J]. Clin Exp Metastasis, 1997, 15(4): 368-381.
4.	Kos J, Stabuc B, Cimerman N, et al. Serum cystatin C, a new marker of glomerular filtration rate, is increased during malignant progression[J]. Clin Chem, 1998, 44(11): 2256-2257.
5.	De Vos J, Thykjaer T, Tarte K, et al. Comparison of gene expression profiling between malignant and normal plasma cells with oligonucleotide arrays[J]. Oncogene, 2002, 21(44): 6848-6857.
6.	張之南, 沈悌. 血液病診斷及療效標準[M]. 2版. 北京: 科學出版社，1998: 168-373.
7.	Herget-Rosenthal S, Marggraf G, Hüsing J, et al. Early detection of acute renal failure by serum cystatin C[J]. Kidney Int, 2004, 66(3): 1115-1122.
8.	Perkins BA, Nelson RG, Ostrander BE, et al. Detection of renal function decline in patients with diabetes and normal or elevated GFR by serial measurements of serum cystatin C concentration: esults of a 4-year follow-up study[J]. J Am Soc Nephrol, 2005, 16(5):1404-1412.
9.	Stevens LA, Coresh J, Schmid CH, et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD[J]. Am J Kidney Dis, 2008, 51(3): 395-406.
10.	Gertz MA, Lacy MQ, Dispenzieri A, et al. Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma[J]. Bone Marrow Transplant，2007, 39(10): 605-611.
11.	Eleutherakis-Papaiakovou V, Bamia A, Gika D, et al. Renal failure in multiple myeloma: incidence correlations, and prognostic significance[J]. Leuk Lymphoma, 2007, 48(2): 337-341.
12.	Brahamson M, Olafsson I, Palsdottir A, et al. Structure and expression of the human cystatin C gene[J]. Biochem J, 1990, 268（2）: 287-294.
13.	Greipp PR, San Miguel J, Durie BG, et al. International staging system for multiple myeloma[J]. J Clin Oncol, 2005, 23(15): 3412-3420.
14.	Finney H, Williams AH, Price CP. Serum cystatin C in patients with myeloma[J]. Clin Chim Acta, 2001, 309(1): 1-6.
15.	Terpos E, Katodritou E, Tsiftsakis E, et al. Cystatin-C is an independent prognostic factor for survival in multiple myeloma and is reduced by bortezomib administration[J]. Haematologica, 2009, 94(3): 372-379.
16.	Choi SJ, Reddy SV, Devlin RD, et al. Identification of human asparaginyl endopeptidase (legumain) as an inhibitor of osteoclast formation and bone resorption[J]. J Biol Chem, 1999, 274(39): 27747-27753.

1. Abbott KC, Agodoal LY. Multiple myeloma and light chain associated nephropathy at end-stage renal disease in the United States: patient characteristics and survival[J]. Clin Nephrol, 2001, 56(3): 207 -210.
2. Lamb EJ, Stowe HJ, Simpson DE, et al. Diagnostic accuracy of cystatin C as a marker of kidney disease in patients with multiple myeloma: calculated glomerular filtration rate formulas are equally useful[J]. Clin Chem, 2004, 50(10): 1848-1851.
3. Heidtmann HH, Salge U, Abrahamson M, et al. Cathepsin B and cysteine proteinase inhibitors in human lung cancer cell lines[J]. Clin Exp Metastasis, 1997, 15(4): 368-381.
4. Kos J, Stabuc B, Cimerman N, et al. Serum cystatin C, a new marker of glomerular filtration rate, is increased during malignant progression[J]. Clin Chem, 1998, 44(11): 2256-2257.
5. De Vos J, Thykjaer T, Tarte K, et al. Comparison of gene expression profiling between malignant and normal plasma cells with oligonucleotide arrays[J]. Oncogene, 2002, 21(44): 6848-6857.
6. 張之南, 沈悌. 血液病診斷及療效標準[M]. 2版. 北京: 科學出版社，1998: 168-373.
7. Herget-Rosenthal S, Marggraf G, Hüsing J, et al. Early detection of acute renal failure by serum cystatin C[J]. Kidney Int, 2004, 66(3): 1115-1122.
8. Perkins BA, Nelson RG, Ostrander BE, et al. Detection of renal function decline in patients with diabetes and normal or elevated GFR by serial measurements of serum cystatin C concentration: esults of a 4-year follow-up study[J]. J Am Soc Nephrol, 2005, 16(5):1404-1412.
9. Stevens LA, Coresh J, Schmid CH, et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD[J]. Am J Kidney Dis, 2008, 51(3): 395-406.
10. Gertz MA, Lacy MQ, Dispenzieri A, et al. Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma[J]. Bone Marrow Transplant，2007, 39(10): 605-611.
11. Eleutherakis-Papaiakovou V, Bamia A, Gika D, et al. Renal failure in multiple myeloma: incidence correlations, and prognostic significance[J]. Leuk Lymphoma, 2007, 48(2): 337-341.
12. Brahamson M, Olafsson I, Palsdottir A, et al. Structure and expression of the human cystatin C gene[J]. Biochem J, 1990, 268（2）: 287-294.
13. Greipp PR, San Miguel J, Durie BG, et al. International staging system for multiple myeloma[J]. J Clin Oncol, 2005, 23(15): 3412-3420.
14. Finney H, Williams AH, Price CP. Serum cystatin C in patients with myeloma[J]. Clin Chim Acta, 2001, 309(1): 1-6.
15. Terpos E, Katodritou E, Tsiftsakis E, et al. Cystatin-C is an independent prognostic factor for survival in multiple myeloma and is reduced by bortezomib administration[J]. Haematologica, 2009, 94(3): 372-379.
16. Choi SJ, Reddy SV, Devlin RD, et al. Identification of human asparaginyl endopeptidase (legumain) as an inhibitor of osteoclast formation and bone resorption[J]. J Biol Chem, 1999, 274(39): 27747-27753.

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多發性骨髓瘤患者血清胱抑素C水平測定

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多發性骨髓瘤患者血清胱抑素C水平測定

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