广西医学

目的探讨多发性骨髓瘤（MM）患者的血清I型原胶原氨基端前肽（PINP）、dickkopf Wnt信号通路抑制因子1（DKK1）和分泌型卷曲相关蛋白3（SFRP3）水平及其临床意义。方法纳入150例MM患者（MM组）及150健康体检者（对照组）。比较两组研究对象之间、不同临床分期MM患者之间、不同临床疗效MM患者之间的血清DKK1、PINP、SFRP3水平。采用Logistic回归模型分析治疗前血清DKK1、PINP和SFRP3水平与MM患者临床疗效的关系。采用受试者工作特征（ROC）曲线分析治疗前血清DKK1、PINP和SFRP3水平对MM患者临床疗效的预测效能。结果 MM组患者治疗前血清DKK1、PINP和SFRP3水平高于对照组（P<0.05）；Ⅰ期、Ⅱ期、Ⅲ期MM患者治疗前血清DKK1、PINP、SFRP3水平依次升高（P<0.05）；有效组患者治疗前血清DKK1、PINP、SFRP3水平低于无效组（P <0.05）。治疗前血清DKK1、SFRP3、PINP水平升高是影响MM患者临床疗效的独立危险因素（P <0.05）。治疗前血清DKK1和SFRP3水平对MM患者临床疗效无预测价值（曲线下面积<0.5，P >0.05），而治疗前血清PINP水平对MM患者的临床疗效有一定的预测价值（曲线下面积=0.663，P <0.05）。结论 MM患者治疗前的血清DKK1、PINP和SFRP3水平高于健康人群，且与疾病严重程度有关，是MM患者临床疗效的影响因素。治疗前血清PINP水平对预测MM患者的临床疗效有一定的价值。

Objective To investigate the levels of serum N-terminal propeptide of type Ⅰ procollagen (PINP), dickkopf Wnt signaling pathway inhibitor 1 (DKK1), and secreted frizzled related protein 3 (SFRP3) in patients with multiple myeloma (MM), and their clinical significance. Methods A total of 150 MM patients (the MM group) and 150 healthy check-up individuals (the control group) were enrolled. The levels of serum DKK1, PINP, and SFRP3 were compared between research subjects of the two groups, between MM patients with different clinical stages, and between MM patients with different clinical efficacy. The relation of pre-treatment serum DKK1, PINP, and SFRP3 levels with MM patients' clinical efficacy was analyzed by employing the Logistic regression model. The receiver operating characteristic (ROC) curve was used to analyze the efficiency of serum DKK1, PINP, and SFRP3 levels for predicting clinical efficacy in MM patients. Results The MM group exhibited higher levels of serum DKK1, PINP, and SFRP3 as compared with the control group (P<0.05), and pre-treatment serum DKK1, PINP, and SFRP3 levels of MM patients were elevated successively in stages Ⅰ, Ⅱ, and Ⅲ (P<0.05). The effective group yielded lower levels of serum DKK1, PINP, and SFRP3 as compared with the ineffective group before treatment (P<0.05). The elevations of pre-treatment serum DKK1, SFRP3, and PINP levels were the independent risk factors for affecting MM patients' clinical efficacy (P<0.05). There was no predictive value of pre-treatment serum DKK1 and SFRP3 levels for MM patients' clinical efficacy (area under the curve<0.5, P>0.05), while pre-treatment serum PINP level exerted predictive value on MM patients' clinical efficacy to a certain extent (area under the curve=0.663, P<0.05). Conclusion Serum DKK1, PINP, and SFRP3 levels of MM patients are higher than those of healthy population, and are related to disease severity, which are the influencing factors for MM patients' clinical efficacy. Pre-treatment serum PINP level exerts a value for predicting MM patients' clinical efficacy to a certain extent.