目的 探讨多发性骨髓瘤患者血清黏蛋白1（MuC1）、Ⅰ型前胶原氨基端延长肽（PINP）、游离轻链（sFLC）与临床分期、免疫分型的关系及对预后的预测价值。 方法 选取2020年7月至2024年5月武威市人民医院收治的220例多发性骨髓瘤患者作为病例组，均根据国际分期系统（ISS）明确分为Ⅰ期26例、Ⅱ期82例和Ⅲ期112例；根据免疫分型明确分为免疫球蛋白（Ig）A型52例、IgG型96例、轻链型47例和非分泌型25例，同时根据治疗随访12个月内患者预后情况分为预后不良组（55例）和预后良好组（165例）。另按照1∶1比例选取同期健康体检者220名作为对照组。比较病例组、对照组临床资料及血清MuC1、PINP、sFLC（包括κ轻链sFLC-κ和λ轻链sFLC-λ），比较不同临床分期及不同免疫分型、不同预后患者血清MuC1、PINP、sFLC水平，并采用受试者工作特征（ROC）曲线分析血清MuC1、PINP、sFLC水平对多发性骨髓瘤患者预后的预测价值。 结果 病例组血清MuC1、sFLC-κ、sFLC-λ水平均高于对照组，血清PINP水平低于对照组（P < 0.05）。Ⅲ期患者血清MuC1、sFLC-κ、sFLC-λ水平高于Ⅰ期、Ⅱ期患者，Ⅱ期患者高于Ⅰ期患者；Ⅲ期患者血清PINP水平低于Ⅰ期、Ⅱ期患者，Ⅱ期患者低于Ⅰ期患者（P < 0.05）。IgG型患者血清MuC1、sFLC-κ、sFLC-λ水平均高于IgA型、轻链型、非分泌型患者，血清PINP水平均低于IgA型、轻链型、非分泌型患者（P < 0.05）。预后不良组血清MuC1、sFLC-κ、sFLC-λ水平高于预后良好组，血清PINP水平低于预后良好组（P < 0.05）。将预后不良纳入阳性，预后良好纳入阴性，血清MuC1、PINP、sFLC-κ、sFLC-λ及联合检测预测多发性骨髓瘤患者预后的曲线下面积（AUC）分别为0.765、0.665、0.753、0.710、0.914，诊断敏感度分别为72.73%、69.09%、72.73%、65.45%、87.27%，特异度分别为69.70%、62.42%、72.12%、73.33%、85.45%，其中联合检测的AUC最高（P < 0.05）。 结论 血清MuC1、PINP、sFLC表达与多发性骨髓瘤的发生、发展及免疫分型有关，且对患者预后预测价值较高，而四者联合检测的预测价值最高。

Objective To explore the relationship between the levels of serum mucin 1 （MuC1）， type Ⅰprocollagen N-terminal propeptide （PINP）， and free light chain （sFLC） in patients with multiple myeloma and their clinical staging， immunophenotyping， and to evaluate their predictive value for prognosis. Methods A total of 220 patients with multiple myeloma admitted to Wuwei People's Hospital between July 2020 and May 2024 were selected as the case group. All patients were clearly staged according to the International Staging System （ISS）： stage Ⅰ （26 cases）， stage Ⅱ （82 cases）， and stage Ⅲ （112 cases）. Based on immunophenotyping， they were further classified into immunoglobulin （Ig） A type （52 cases）， IgG type （96 cases）， light chain type （47 cases）， and non-secreting type （25 cases）. Moreover， according to the patients' prognosis within 12 months of treatment follow-up， they were divided into the poor prognosis group （55 cases） and the good prognosis group （165 cases）. A control group of 220 healthy individuals who underwent physical examinations during the same period was also selected at a ratio of 1∶1. The clinical data and levels of serum MuC1， PINP， and sFLC （including sFLC-κ and sFLC-λ for horizontal κ and λ light chains） were compared between the case group and the control group. The levels of serum MuC1， PINP， and sFLC were also compared among patients with different clinical stages， immunophenotypes， and prognoses. The predictive value of serum MuC1， PINP， and sFLC levels for the prognosis of multiple myeloma patients was evaluated by receiver operating characteristic （ROC） curve analysis. Results The levels of serum MuC1， sFLC-κ， and sFLC-λ in the case group were significantly higher than those in the control group， whereas the level of serum PINP was significantly lower than that in the control group （P < 0.05）. In patients， the levels of serum MuC1， sFLC-κ， and sFLC-λ in stage Ⅲ were significantly higher than those in stages Ⅰ and Ⅱ， and the levels in stage Ⅱ were significantly higher than those in stage Ⅰ （P < 0.05）. Conversely， the level of serum PINP in stage Ⅲ was significantly lower than that in stages Ⅰ and Ⅱ， and the level in stage Ⅱ was significantly lower than that in stage Ⅰ （P < 0.05）. In terms of immunoglobulin types， the levels of serum MuC1， sFLC-κ， and sFLC-λ in patients with IgG type were significantly higher than those in patients with IgA type， light chain type， and non-secreting type， while the level of serum PINP was significantly lower than that in patients with these types （P < 0.05）. Regarding prognosis， the levels of serum MuC1， sFLC-κ， and sFLC-λ in the poor prognosis group were significantly higher than those in the good prognosis group， while the level of serum PINP was significantly lower than that in the good prognosis group （P < 0.05）. When defining poor prognosis as positive and good prognosis as negative， the area under the curve （AUC） for predicting the prognosis of multiple myeloma patients using serum MuC1， PINP， sFLC-κ， sFLC-λ， and their combined detection were 0.765， 0.665， 0.753， 0.710， and 0.914， respectively. The diagnostic sensitivities were 72.73%， 69.09%， 72.73%， 65.45%， and 87.27%， respectively， and the specificities were 69.70%， 62.42%， 72.12%， 73.33%， and 85.45%， respectively. Among these， the combined detection had the highest AUC （P < 0.05）. Conclusion The expressions of serum MuC1， PINP， and sFLC were associated with the occurrence， progression， and immunophenotyping of multiple myeloma， and they had high predictive value for patient prognosis. The combined detection of these four markers had the highest predictive value.