急性淋巴细胞白血病患者血清乳酸脱氢酶和维生素D水平与其预后的关系  

The correlation of serum lactate dehydrogenase and vitamin D levels with prognosis of patients with acute lymphocytic leukemia

作　　者：吴必嘉[1] 龚峻梅[1] 陈娟娟[1] 郭天剑[1] 方明[2] 黄斯勇[3] 

机构地区：[1]中国人民解放军第四二一医院血液科,广东广州510318 [2]广州市红十字会医院血液科,广东广州510220 [3]第四军医大学唐都医院血液内科,陕西西安710032

出　　处：《广东医学》2017年第7期1009-1013,共5页Guangdong Medical Journal

基　　金：国家自然科学基金资助项目(编号:81300397)

摘　　要：目的探讨急性淋巴细胞白血病(ALL)患者血清乳酸脱氢酶(LDH)和维生素D水平与其预后的关系。方法选取成人初治ALL患者63例为ALL组,行大剂量甲氨蝶呤治疗并随访至少1年。并以同期健康查体志愿者30例为对照组。检测比较两组血清LDH和25-羟维生素D[25(OH)D]水平及同期急性生理和慢性健康评分(APACHEⅡ评分)。统计ALL组随访1年的生存预后。分析ALL患者血清LDH和25(OH)D水平与其APACHEⅡ评分及1年生存率的关系及其预测1年生存预后的价值。结果与对照组比较,ALL组治疗前血清LDH水平和APACHEⅡ评分升高而血清25(OH)D水平则降低(P<0.05)。与治疗前比较,ALL组治疗后3d和治疗后1个月的血清LDH水平和APACHEⅡ评分降低而血清25(OH)D水平则升高(P<0.05)。ALL组1年生存率为80.95%。与ALL组存活患者比较,ALL组死亡患者治疗前后的血清LDH水平和APACHEⅡ评分升高而血清25(OH)D水平则降低(P<0.05)。Spearman无条件相关分析结果显示,ALL患者血清LDH水平与APACHEⅡ评分呈正相关(r=0.868,P<0.05)而与1年生存率呈负相关(r=-0.892,P<0.05),其血清25(OH)D水平与APACHEⅡ评分呈负相关(r=-0.705,P<0.05)而与1年生存率呈正相关(r=0.826,P<0.05)。ROC曲线分析结果显示,ALL患者治疗前、治疗后3d和治疗后1个月的血清LDH和25(OH)D水平联合预测其1年生存预后的准确性分别为88.89%、95.24%和98.41%。结论 ALL患者血清LDH和25(OH)D水平与病情相关且联合预测患者预后的价值良好,可能作为ALL患者病情和预后评估的参考指标。Objective To investigate the correlation between serum lactate dehydrogenase （LDH） or vitamin D and prognosis of patients with acute lymphocytic leukemia （ALL）. Methods Sixty - three adult patients with ALL and had first time treatment were selected as ALL group, whom were treated with high - dose methotrexate therapy and followed up for at least 1 year. And 30 healthy volunteers had physical exam in the same period were selected as control group. Ser- um LDH and 25 -hydroxyl vitamin D [ 25 （OH）D ] levels, and acute physiology and chronic health evaluation （APACHE II ） were assessed and compared. One - year survival prognosis of ALL group was statistically analyzed. Correlation be- tween serum LDH and 25 （OH） D levels with the APACHE ]I scores and 1 - year survival rate of ALL patients were ana- lyzed. Results Before treatment, serum LDH level and APACHE 11 scores in ALL group were significantly higher than control group, while serum 25 （OH） D level was lower （P 〈0. 05）. Compared with before treatment, serum LDH level and APACHE I] scores in ALL group were significantly lower 3 days and 1 month after treatment, while the serum 25 （OH） D levels were significantly elevated （P 〈 0.05 ）. ;Fhe 1 -year survival rate in ALL group was 80.95%. Compared with survive patients in ALL group, serum LDH levels and APACHE I] scores before and after treatment in death patients were significantly higher, while serum 25 （OH） D levels were per contra （P 〈 0. 05 ）. Unconditional Spearman correlation analysis results showed that serum LDH level in ALL patients was significantly positively correlated with APACHE I1 scores （ r = 0. 868, P 〈 O. 05）, while negatively correlated with 1 - year survival rate （r = - 0. 892, P 〈 0. 05） ; and ser- um 25（OH） D level was significantly negatively correlated with APACHE II scores （r = -0. 705, P 〈0. 05） , while posi- tively correlated with 1 - year survival rates （ r = 0. 826, P 〈 0. 05 ）. According to the results of ROC

关 键 词：急性淋巴细胞白血病 乳酸脱氢酶 维生素D 预后 关系 

分 类 号：R733.71[医药卫生—肿瘤]