| Objective:To explore the clinical significance of hemorheology and D-dimer in the diagnosis and prognosis of patients with multiple myeloma(Multiple myeloma,MM).Methods:1.The clinical data and related examination results of 83 newly diagnosed MM patients in the Hematology Department of Northern Jianfsu People’s Hospital from December 1,2015 to December 30,2019 were analyzed retrospectively,including sex,age,hemoglobin concentration,platelet count,serum lactate dehydrogenase(LDH),globulin,creatinine and ISS stages.The hemorheological indexes(whole blood viscosity low shear,middle shear,high shear,and plasma viscosity)and D-dimer were measured in all patients.Hemorheological indexes and D-dimer were reexamined in 31 patients during treatment.In addition,the hemorheological indexes(whole blood viscosity low shear,middle shear,high shear,and plasma viscosity)and D-dimer were collected as healthy control group.The age and number of patients in this control group were similar to those of MM patients,and there were no factors affecting hemorheology and D-dimer such as hypertension,diabetes,coronary heart disease and infection.2.The curative effect of MM patients was evaluated by analyzing their clinical data and overall survival(OS)time was determined by telephone follow-up or hospitalization medical records.Result:1.General data: among the 83 patients selected in this study,54 were male(65.1%)and 29 were female(34.9%).The average age was 64 ±10years old.Ig G type is the most common type in immunophenotype.In ISS clinical staging,there were 13 patients in stage I(15.7%),28 patients in stage II(33.7%)and 42 patients in stage III(50.6%).2.The D-dimer and hemorheology indexes(plasma viscosity,whole blood viscosity low shear,middle shear,high shear)were compared between the healthy control group and the newly diagnosed MM patients.The results showed that the plasma viscosity and D-dimer in the MM patients were higher than those in the healthy control group,and the whole blood viscosity(low shear,middle shear,high shear)in the MM patients was lower than that in the healthy control group.3.The indexes of hemorheology and D-dimer were compared before and after treatment,in which plasma viscosity decreased(1.44 m Pa.s VS1.29 m Pa.s),(P < 0.05),whole blood viscosity low shear,whole blood viscosity middle shear and whole blood viscosity high shear increased,but the degree of increase was not statistically significant(P > 0.05).The level of D-dimer was lower than that before treatment,but the difference was not statistically significant(P > 0.05).4.Subgroup definition: the D-dimer and plasma viscosity of patients with MM were collected,and their average values were divided into high group and low group.(1).The patients were divided into two groups: high average D-dimer group(≥ 1.47mg/L)and low D-dimer average group(< 1.47mg/L);(2).The patients were divided into two groups: high average plasma viscosity group(≥ 1.42 m Pa.s)and low plasma viscosity group(<1.42 m Pa.s).5.Data analysis of different groups: d-dimer ≥ 1.47mg/L was more likely to occur in patients with higher LDH value and later ISS stage,while plasma viscosity ≥ 1.42 m Pa.s group was more likely to occur in patients with late ISS stage,low hemoglobin and high globulin(P < 0.05).6.Survival analysis: after follow-up from 1 to 48 months,Kaplan-Meier survival analysis showed that the OS of high D-dimer group(≥ 1.47mg/L)was shorter than that of low D-dimer group(< 1.47mg/L)(P < 0.05),but There was no significant difference in OS of plasma viscosity between the two groups(P > 0.05).7.Multivariate Cox proportional hazard model suggested that D-dimer≥ 1.47mg/L and LDH were independent risk factors for OS in patients with MM.Conclusion:There are differences in hemorheological indexes and D-dimer between MM patients and healthy controls at the first visit,so it is suggested that these two kinds of indexes can be used as auxiliary basis for diagnosis.In the course of treatment,the dynamic detection of hemorheological indexes and D-dimer showed that the plasma viscosity increased after treatment,and the whole blood viscosity in low shear,middle shear and high shear decreased compared with that before treatment.but there was no statistical difference in the degree of decrease;D-dimer decreased compared with that before treatment,but there was no significant statistical difference.High D-dimer in prognostic analysis indicates poor prognosis and can be used as an index to evaluate the prognosis of patients with MM.The hemorheological indexes had no significant effect on the prognosis in this study. |
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