急性早幼粒细胞白血病预后生存模型的建立

doi:10.3969/j.issn.1673-8640.2021.3.012

检验医学 ›› 2021, Vol. 36 ›› Issue (3): 292-295.DOI: 10.3969/j.issn.1673-8640.2021.3.012

急性早幼粒细胞白血病预后生存模型的建立

沈晓雅¹, 娄引军², 王文娟¹()

1.浙江大学医学院附属第一医院检验科,浙江杭州 310000
2.浙江大学医学院附属第一医院血液科,浙江杭州 310000

收稿日期:2019-09-18 出版日期:2021-03-30 发布日期:2021-03-30
通讯作者: 王文娟
作者简介:王文娟,E-mail：zyyywwj3075@zju.edu.cn。
沈晓雅,女,1997年生,学士,技师,主要从事医学检验工作。

Establishment of survival model for predicting prognosis of patients with acute promyelocytic leukemia

SHEN Xiaoya¹, LOU Yinjun², WANG Wenjuan¹()

1. Department of Clinical Laboratory,the First Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310000,Zhejiang,China
2. Department of Hematology,the First Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310000,Zhejiang,China

Received:2019-09-18 Online:2021-03-30 Published:2021-03-30
Contact: WANG Wenjuan

摘要/Abstract

摘要：

目的分析影响急性早幼粒细胞白血病（APL）预后的危险因素,并以多参数指标建立APL患者的预后生存模型。方法选取2013年7月—2017年7月浙江大学医学院附属第一医院218例APL患者作为研究对象,将患者分为早期死亡组（18例）和非早期死亡组（200例）,分析影响APL预后的危险因素,并建立预后生存模型。结果年龄>60岁、白细胞（WBC）计数>10×10 ⁹/L、纤维蛋白原（Fib）≤1.4 g/L、血清肌酐（SCr）>105 μmol/L、血清乳酸脱氢酶（LDH）>250 U/L、早幼粒细胞白血病-维甲酸受体α（PML-RARa）融合基因SG阳性与APL患者早期死亡密切相关（P<0.05）;多因素Logistic回归分析发现,年龄[比值比（OR）=1.049,95%可信区间（CI）为1.003~1.098,P=0.038]和WBC计数（OR=1.030,95%CI为1.007~1.054,P=0.012）为APL患者预后的独立危险因素;预后生存模型根据初诊时APL患者年龄、WBC计数、Fib、LDH、SCr、PML-RARa融合基因亚型6项指标建立,其受试者工作特征（ROC）曲线的曲线下面积（AUC）为0.797,敏感性为71.4%,特异性为92.6%。结论年龄、WBC计数为APL预后的独立危险因素,所建立的预后生存模型对预测患者生存状态有重要意义。

关键词: 急性早幼粒细胞白血病, 早期死亡, 预后生存模型

Abstract:

Objective To analyze the risk factors for the prognosis of acute promyelocytic leukemia（APL）,and to establish the survival model of APL with multiple parameters. Methods A total of 218 patients with APL treated in our hospital from July 2013 to July 2017 were enrolled. The patients were divided into early death group（18 cases）and non-early death group（200 cases）. The risk factors for the prognosis of APL were analyzed,and the survival model was established. Results Patient's age >60 years old,white blood cell（WBC） count>10×10⁹/L,fibrinogen（Fib）≤1.4 g/L,serum creatinine（SCr）>105 μmol/L,lactate dehydrogenase（LDH）>250 U/L,positive PML-RARα fusion gene SG were closely related to early death（P<0.05）. Multivariate Logistic analysis showed that age [odds ratio（OR）=1.049,95% confidence interval（CI） 1.003-1.098,P=0.038] and WBC count（OR=1.030,95%CI 1.007-1.054,P=0.012） were independent risk factors for APL prognosis. The model for predicting the patient's survival was established by the indicators of age,WBC count,Fib,LDH,SCr,and PML-RARα fusion gene subtype at initial diagnosis,and evaluated by receiver operating characteristic（ROC）curve. The area under curve（AUC） was 0.797,the sensitivity was 71.4%,and the specificity was 92.6%.Conclusions Age and WBC count are independent risk factors for APL prognosis. The established model can be explored in predicting the survival status of patients.

Key words: Acute promyelocytic leukemia, Early death, Survival model

中图分类号:

R552

沈晓雅, 娄引军, 王文娟. 急性早幼粒细胞白血病预后生存模型的建立[J]. 检验医学, 2021, 36(3): 292-295.

SHEN Xiaoya, LOU Yinjun, WANG Wenjuan. Establishment of survival model for predicting prognosis of patients with acute promyelocytic leukemia[J]. Laboratory Medicine, 2021, 36(3): 292-295.

图/表 2

参考文献 13

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组别	例数	性别			年龄			WBC计数			PLT计数
组别	例数	男	女		≤60岁	>60岁		≤10×10⁹/L	>10×10⁹/L		≤30×10⁹/L	>30×10⁹/L
非早期死亡组	200	100	100		176	24		148	52		111	89
早期死亡组	18	13	5		10	8		9	9		14	4
χ²值		3.266			13.880			4.720			3.351
P值		0.071			<0.01			0.030			0.067
组别	例数	Fib				LDH				DD
组别	例数	≤1.4 g/L	>1.4 g/L	缺失		≤250 U/L	>250 U/L	缺失		≤20 000 μg/L	>20 000 μg/L	缺失
非早期死亡组	200	104	94	2		72	110	18		149	50	1
早期死亡组	18	14	4	0		2	13	3		12	6	0
χ²值		4.245				4.064				0.581
P值		0.039				0.044				0.446
组别	例数	SCr				骨髓原始+早幼粒细胞比例				PML-RARa融合基因亚型
组别	例数	≤105 μmol/L	>105 μmol/L			≤70%	>70%	缺失		SG阳性	LG阳性	缺失
非早期死亡组	200	194	6			23	138	39		74	120	6
早期死亡组	18	13	5			1	17	0		11	5	2
χ²值		21.160				1.063				5.747
P值		<0.01				0.303				0.017

组别	例数	性别			年龄			WBC计数			PLT计数
组别	例数	男	女		≤60岁	>60岁		≤10×10⁹/L	>10×10⁹/L		≤30×10⁹/L	>30×10⁹/L
非早期死亡组	200	100	100		176	24		148	52		111	89
早期死亡组	18	13	5		10	8		9	9		14	4
χ²值		3.266			13.880			4.720			3.351
P值		0.071			<0.01			0.030			0.067
组别	例数	Fib				LDH				DD
组别	例数	≤1.4 g/L	>1.4 g/L	缺失		≤250 U/L	>250 U/L	缺失		≤20 000 μg/L	>20 000 μg/L	缺失
非早期死亡组	200	104	94	2		72	110	18		149	50	1
早期死亡组	18	14	4	0		2	13	3		12	6	0
χ²值		4.245				4.064				0.581
P值		0.039				0.044				0.446
组别	例数	SCr				骨髓原始+早幼粒细胞比例				PML-RARa融合基因亚型
组别	例数	≤105 μmol/L	>105 μmol/L			≤70%	>70%	缺失		SG阳性	LG阳性	缺失
非早期死亡组	200	194	6			23	138	39		74	120	6
早期死亡组	18	13	5			1	17	0		11	5	2
χ²值		21.160				1.063				5.747
P值		<0.01				0.303				0.017

急性早幼粒细胞白血病预后生存模型的建立

Establishment of survival model for predicting prognosis of patients with acute promyelocytic leukemia

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