儿童急性髓系白血病中血清生长分化因子15的表达水平与预后关系的研究  

Study on the relationship between the expression of serum growth differentiation factor 15 and prognosis in children with acute myeloid leukemia

作　　者：单新洁 祁晓婷[2] SHAN Xinjie;QI Xiaoting(Department of Clinical Laboratory,the Xinjiang Uygur Autonomous Region Children′s Hospital,Urumqi,Xinjiang 830001,China;Department of Clinical Laboratory,the Xinjiang Uygur Autonomous Region People′s Hospital,Urumqi,Xinjiang 830001,China)

机构地区：[1]新疆维吾尔自治区儿童医院检验科,新疆乌鲁木齐830001 [2]新疆维吾尔自治区人民医院临检中心,新疆乌鲁木齐830001

出　　处：《国际检验医学杂志》2019年第21期2633-2636,共4页International Journal of Laboratory Medicine

基　　金：新疆维吾尔自治区自然科学基金资助项目(2015D01C129)

摘　　要：目的探究儿童急性髓系白血病(AML)中血清生长分化因子15(GDF15)的表达水平与预后的关系。方法对2012年1月至2014年8月在新疆维吾尔自治区人民医院治疗的94例AML患儿进行前瞻性分析和随访,并选择体检健康儿童100例作为对照组,比较AML患儿治疗前后血清GDF15的表达水平,分析死亡与生存患儿临床资料间的差异,应用多因素Cox回归模型探究影响AML患儿预后的独立危险因素,并应用受试者工作特征曲线(ROC曲线)评估对预后的预测价值。结果AML患儿治疗前后血清GDF15水平均显著高于对照组(P<0.05),治疗后AML患儿血清GDF15水平较治疗前显著下降(P<0.05)。随访中发生全因死亡33例,死亡组治疗后血清GDF15水平、中枢神经系统白血病(CNSL)发生率明显高于生存组(P<0.05),首疗程完全缓解(CR)率显著低于生存组(P<0.05)。治疗后血清GDF15、发生CNSL是AML患儿预后的独立危险因素(HR=28.959、12.284,P=0.000、0.005),首疗程CR是AML患儿预后的独立保护因素(HR=0.174,P=0.006)。治疗后血清GDF15预测AML患儿预后的ROC曲线下面积(AUC)显著高于发生CNSL及首疗程CR(Z=2.179、2.031,P=0.029、0.042),其最佳临界值为≥406.351 ng/mL,灵敏度和特异度分别为97.88%和69.23%。结论AML患儿治疗后血清GDF15是影响其预后的独立危险因素,并对患儿预后具有较高的预测价值。Objective To investigate the expression of serum growth differentiation factor 15(GDF15)in children with acute myeloid leukemia(AML)and its relationship with prognosis.Methods A prospective analysis and follow-up of 94 AML children treated in People′s Hospital of Xinjiang Uygur Autonomous Region from January 2012 to August 2014 were carried out.A total of 100 healthy children were selected as control group.The expression levels of serum GDF15 in AML children before and after treatment were compared.The differences between clinical data of death and survival children were analyzed.The uniqueness of prognosis of AML children was explored by using multivariate Cox regression model.Risk factors were established and the predictive value of prognosis were evaluated by receiver operating characteristic curve(ROC curve).Results The serum GDF15 level of AML children before and after treatment was significantly higher than that of the control group(P<0.05),and the serum GDF15 level of AML children after treatment was significantly lower than that before treatment(P<0.05).There were 33 all-cause deaths during follow-up.The serum levels of GDF15 and the incidence of central nervous system leukemia(CNSL)in the death group were significantly higher than those in the survival group(P<0.05),and the complete remission(CR)rate in the first course of treatment was significantly lower than that in the survival group(P<0.05).Serum GDF15 and CNSL after treatment were independent risk factors for the prognosis of AML children(HR=28.959,12.284,P=0.000,0.005).CR during the first course of treatment was an independent protective factor for the prognosis of AML children(HR=0.174,P=0.006).After treatment,the area under ROC curve(AUC)of serum GDF15 in predicting the prognosis of AML was significantly higher than that of CNSL and CR in the first course(Z=2.179,2.031,P=0.029,0.042).The optimal threshold value was≥406.351 ng/mL,with sensitivity and specificity of 97.88%and 69.23%,respectively.Conclusion Serum GDF15 is an independent risk fa

关 键 词：急性髓系白血病 血清生长分化因子15 预后 

分 类 号：R725.5[医药卫生—儿科]