| Objective:(1)To analyse the relationship between the inflammatory factors including Vitamin D3,PIPN,and TRACP-5b)and bone damages,and explore the role and mechanism of these factors in multiple myeloma bone disease;(2)To investigate the value of these factors in the assessment of the therapeutic effect by comparing the changes of Vitamin D3,PINP,and TRACP-5b before and after treatment,meanwhile,investigate the diagnosed value of TRACP-5b/PINP in the myeloma bone disease.Subjects and Methods(1)Subjects: Patients who were diagnosed with multiple myeloma in Henan University People’s Hospital from April 2015 to October 2016 and voluntarily joined this research.A total of 37 patients including 23 males and 14 females were enrolled,with the median age of 56(43-71)years.Of them,5 patients without bone pain(13.5%),7 cases of mild pain(18.9%),17 cases of moderate pain(45.9%),8 cases with severe pain(21.6%);according to imaging MBD classification,13 cases of grade 0(35.1%),0 cases of grade 1,6 cases of grade 2(16.2%),8 cases of grade 3(21.6%),10 cases of grade 4(27%).(2)Methods: According to the patients’ clinical symptoms and imagining characeristics,we divided them into MBD group and Non-MBD group;All the patients were drawn fasting venous blood samples before the treatment and on the 10 th day after the two courses of treatment as well as the 10 th day after the four courses of treatment.After that,we tested the serum concentration of vitamine D3、TRACP-5b、PINP、β-CTX、s RANKL、OPG、MIP1-α and IL-6 by enzyme-linked immunosorbent assay(ELISA);meanwhile,the assessment of therapeutic effect was performed by the condition of bone pain relief、imaginal characteristics、bone marrow morphocytology and serological indicators.(3)The curative effect evaluation standard: the effective treatment of MBD,defined as IMWG efficacy evaluation reaches partial remission(PR)or above,and MBD imaging remission accompanied with pain relief to reduce more than 1 differential.Results: 1.MBD group 26 cases while Non-MBD group 11 cases.MBD group and Non-MBD group showed no significant difference in gender,age,ISS stage ane the proportion of renal damages.2.The concentration of Vitamin D3 in serum in newly diagnosed MBD group was 15.46±6.47ng/ml,while that in Non-MBD group was 7.22±4.68ng/ml(T=3.811,P=0.001);after two courses of treatment,the serum Vitamin D3 in MBD group decreased to 13.24±5.30ng/ml,which still higher than those in Non-MBD group at 8.36±5.05ng/ml(T=2.549,P=0.014);after four courses of treatment,serum Vitamin D3 in MBD group were further reduced to 9.19±3.93ng/ml,close to the Non-MBD group at 7.68±3.89 ng/ml,but there were no significant differences(T=1.071,P=0.291);in addition,the serum Vitamin D3 in the valid group was 8.41±3.42ng/ml whilst that in the invalid was 12.49±3.42 ng/ml after four courses(T=2.256,P=0.033).3.The concentration of PINP in newly diagnosed MBD group was 54.68±42.0 pg/ml,while that in Non-MBD group was 152.58±61.71 pg/ml(T=5.611,P<0.001);after two courses and four courses of treatment,the serum PINP in MBD group was 80.90±47.43pg/ml and 92.75±49.10pg/ml,respectively,while those in Non-MBD group at 45.47±64.67pg/ml and 141.65±65.52pg/ml(T2=-3.391,P2=0.002;T4=-2.502,P4=0.017);in addition,the serum PINP in the valid group was 97.21±51.19 pg/ml which lowered than that in non-MBD group at 141.65±65.52 pg/ml after four courses(T=2.119,P=0.042).4.The concentration of TRACP-5b in newly diagnosed MBD group was 49.02±14.37 m IU/ml,while that in Non-MBD group was 27.11±11.75 m IU/ml(T=4.458,P<0.001);the concentration of TRACP-5b in the patients with Grade3-4 bone damages showed in imaging findings than that in the patients with Grade1-2 bone damages(53.50±13.08 m IU/ml vs.40.18±11.94 m IU/ml);after two courses and four courses of treatment,the serum TRACP-5b in MBD group decreased to 35.17±12.13 m IU/ml and 31.51±10.68 m IU/ml,while those in Non-MBD group were 28.49±10.12 ng/ml and 25.49±7.17 m IU/ml,respectively(T2=1.603,P2=0.118;T4=1.708,P4=0.097).5.The incidence of newly diagnosed patients with TRACP-5b/PINP >=0.50 in MBD group was close to 100%,Of which,95.8% patients presented with bone pain and(or)bone damages detected by radiographic evidence,45.8% patients with hypercalcemia;the indexes that reflect the activity of osteoclast,such as IL-6,RANKL/OPG,beta-CTX in patients with TRACP-5b/PINP >=0.50 are higher than those in patients with TRACP-5b/PINP <0.50(P=0.003,<0.001,=0.009,respectively);meanwhile,the indexes that reflect the severity of disease including HGB,beta2-MG,the percentage of bone marrow plasma cells and immature plasma cells in patients with TRACP-5b/PINP >=0.50 are higher than those in patients with TRACP-5b/PINP <0.50(P=0.003,=0.006,=0.002,respectively)Conclusion: 1.The concentration of serum Vitamin D3 of newly diagnosed multiple myeloma patients with bone damage is higher;the bone damage is severer when the activity of osteoblast is stronger with higher concentration of serum Vitamin D3,which indicating that Vitamin D3 can enhance the activity of osteoblasts,causing skeletal injury.2.The concentration of serum Vitamin D3 of MBD group did not occur obvious changement while valid group decreased,in that it can be used as an index in assessment of response.3.The concentration of serum PINP increased in the valid group,but still lower than that without bone damages,suggesting that the activity of osteoblast recovered slowly,and it takes more time to repair bone damage;4.The concentration of serum TRACP-5b is positive correlation with the degree of bone damages,and it can be used to assess the severity of multiple myeloma.5.The ratio of TRACP-5b/PINP could be used as one of effective index in the diagnosis of myeloma bone disease. |
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