Analysis Of Serum Levels Of EPO,IL-6,TNF-α And IL-1β In Patients With Multiple Myeloma And Their Correlation With Anemia

BackgroundMultiple myeloma(MM)is a malignant proliferative disease of plasma cells.The pathogenesis is clonal plasma cells dysplasia and secretion of monoclonal immunoglobulin or its fragments,resulting in target organs or tissues damage,such as bone pain and osteolytic lesions,anemia,renal function damage,hypercalcemia,hyperviscosity,repeated infection and other clinical manifestations.So far,MM is still an incurable disease,but with the improvement of related diagnostic technology and the application of new drugs such as bortezomib,the diagnosis and treatment of MM has made great progress,and even gradually become a controllable chronic diseease.Anemia is one of the most common complications of MM.The detection rate of anemia in newly diagnosed patients is about 70%.In the process of disease progression,most patients will have anemia.Anemia can have a series of effects on patients according to its severity:first of all,anemia will cause tissue hypoxia,which can be manifested as physical weakness,fatigue,sensory symptoms,cognitive impairment,emotional-emotional disorders and even abnormal behavioral and physiological characteristics,which have a great impact on patients’ quality of life and daily activities.Secondly,anemia can induce or aggravate hypoxic and ischemic complications,which has a great impact on the cardiovascular system.In addition,most of the patients with MM are elderly,which is more likely to induce ischemic cardiomyopathy.Third,anemia has been proved to be an independent poor prognostic factor of MM,which is related to the decrease of survival rate of patients.Anemia,as a staging criterion,can reflect the disease progression of patients.Finally,some studies have shown that anemia is beneficial to tumor growth and tumor cell resistance to radiotherapy and chemotherapy.The pathogenesis of MM anemia is very complex and has not been fully understood so far.Studies have shown that the mechanisms of MM anemia mainly include myeloma cells infiltrating into the bone marrow cavity to inhibit erythroid production,renal function damage leading to renal anemia(RA),chemotherapy-induced myelosuppression,autoimmune hemolytic anemia(AIHA),recurrent infection,elevated blood viscosity,erythroid progenitor cell apoptosis induced by FAS-L and TRAIL,and cytokines interleukin-6(IL-6).Anemia of chronic diseases such as tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β).The aim of this study was to detect the serum levels of EPO,IL-6,TNF-α and IL-1β in MM patients and analyze their correlation with anemia,to futher explore the mechanism of action of these cytokines in MM anemia,to provide clinical evidence for the study of the mechanism of MM anemia,and to provide a basis for clinical treatment of anemia in MM patients.ObjectiveTo investigate the levels of serum EPO,IL-6,TNF-α and IL-1β in patients with MM with different Durie-Salmon stages,and to analyze their correlation with anemia.Method52 patients with MM diagnosed in the first affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were selected as the experimental group,and 18 healthy subjects in the same period were selected as the normal control group.The levels of serum EPO,IL-6,TNF-α and IL-1β were detected by enzyme linked immunosorbent assay(Elisa),and the level of hemoglobin(Hb)was detected by automatic hematology analyzer.The correlations between serum levels of EPO,IL-6,TNF-α,IL-1β and Hb in patients with MM were further analyzed.Results①The levels of EPO,IL-6,TNF-α and IL-1β in the experimental group were significantly higher than those in the control group(p<0.05).②In the experimental group,the levels of IL-6,TNF-α and IL-1β in stageⅠ,stage Ⅱ and stage Ⅲ showed an increasing trend.There was no significant difference in IL-6 levels between stage Ⅰ and stage Ⅱ(P>0.05),but there was significant difference between stage Ⅱ and-stage Ⅲ(P<0.05).There was no significant difference in TNF-α and IL-1β between stage Ⅰ and stage Ⅱ,stageⅡ and stage Ⅲ(P>0.05).There was significant difference between stage I and stage Ⅲ(P<0.05).③In the experimental group,the level of EPO in stage Ⅱ was significantly higher than that in stage Ⅰ and stage Ⅲ(P<0.05),and that in stage Ⅲ was higher than that in stage Ⅰ,but the difference was not statistically significant(P>0.05).④ The level of EPO in the normal renal function group(type A)in the experimental group was significantly higher than that in the renal function damage group(type B)and the control group(p<0.05).The level of EPO in the renal function damage group in the experimental group was higher than that in the control group,but the difference was not statistically significant(P>0.05).⑤The level of Hb in the experimental group was negatively correlated with the levels of EPO,IL-6,TNF-α and IL-1β,respectively(P<0.05).Concluson1.The level of serum EPO in patients with MM is increased,but its secretion is still relatively insufficient.2.The decrease of EPO secretion caused by renal damage in patients with MM is one of the pathogenesis of MM anemia.3.The levels of serum IL-6,TNF-α and IL-1β in patients with MM are increased,and the elevated levels of IL-6,TNF-α and IL-1β in patients with MM may be related to the aggravation of anemia.