目的：探究伴有肾损害（RI）的多发性骨髓瘤（MM）患者与无RI患者间是否存在免疫学指标差异。方法：用2017年1月至2023年8月在兰州大学第二医院收治的134例首次确诊为MM的患者相关信息进行回顾性分析，研究对比RI组和非RI组及Durie?Salmon（DS）分期和危险分层两个亚组的10种免疫学指标和6个常规血液学参数的差异。结果：RI组外周血中性粒细胞/淋巴细胞比值（NLR）、外周血单核细胞/淋巴细胞比值（MLR）、CD8+ T细胞比例、IL-10均较非RI组高（均P<0.05），淋巴细胞绝对值、CD4/CD8比值均较非RI组低（均P<0.05）。DS-Ⅲ分期患者中，RI组NLR、MLR、CD8+ T细胞比例、IL-8、IL-10均较非RI组升高（均P<0.05），而DS-Ⅰ和DS-Ⅱ患者中 ，RI 组和非RI组患者免疫指标无明显差异。高危MM患者RI组淋巴细胞数、NLR、IL-10均较非RI有明显差异（均P<0.05）。结论：伴RI的MM患者免疫相关指标异常更为明显，DS-Ⅲ分期和高危险度分层表现出明显的免疫指标异常，本研究结果对进一步阐明MM伴有RI患者预后较差的原因及个体化治疗提供参考依据。

Objective: To investigate whether there are differences in immunological indicators between multiple myeloma (MM) patients with renal impairment (RI) and those without. Methods: A retrospective analysis was conducted on 134 patients who were admitted to the Second Hospital of Lanzhou University and first diagnosed with MM from January 2017 to August 2023. The study compared the differences in 10 immunological indicators and 6 routine hematological parameters between the RI group and the non-RI group, as well as the Durie?Salmon (DS) staging and risk stratification subgroups. Results: The peripheral blood neutrophil/lymphocyte ratio (NLR), peripheral blood monocyte/lymphocyte ratio (MLR), CD8+ T cell ratio, and IL-10 in the RI group were all higher than those in the non-RI group (all P<0.05), while the absolute value of lymphocytes and CD4/CD8 ratio were both lower than those in the non-RI group (both P<0.05). In DS-Ⅲ stage patients, the proportion of NLR, MLR, CD8+ T cells, IL-8, and IL-10 in the RI group were all higher than those in the non-RI group (all P<0.05). However, there was no significant difference in immune indicators between the RI and non-RI groups in DS-Ⅰ and DS-Ⅱ patients. The number of lymphocytes, NLR, and IL-10 in the RI group of high-risk MM patients showed significant differences compared to those in non-RI patients (all P<0.05). Conclusion: Immunological abnormalities are more pronounced in MM patients with RI, and significant immune abnormalities are observed in DS-Ⅲ staging and high-risk stratification. The results of this study provide a reference for further elucidating the reasons for poor prognosis in MM patients with RI and personalized treatment.

国家自然科学基金（No.8236010019）；甘肃省自然科学 基金（N0.21JR7RA435）；甘肃省自然科学基金（2N0.1JR7RA394）；甘 肃省自然科学基金（N0.21JR11RA104）；甘肃省兰州市科技计划 （N0.2020-ZD-99）