血清乳酸脱氢酶对儿童急性淋巴细胞白血病预后的预测价值  

Predictive Value of Serum Lactate Dehydrogenase on the Prognosis of Children with Acute Lymphoblastic Leukemia

作　　者：冉玉 刘玉峰[1] 魏会霞[1] 苏淑芳[1] 魏林林[1] 李白[1] 张林楠 RAN Yu;LIU Yufeng;WEI Huixia;SU Shufang;WEI Linlin;LI Bai;ZHANG Linnan(Department of Hematology and Oncology,Children’s Hospital,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Pediatrics,Xi’an Children’s Hospital,Xi’an 710003,China)

机构地区：[1]郑州大学第一附属医院儿童医院血液肿瘤科,河南郑州450052 [2]西安市儿童医院儿科,陕西西安710003

出　　处：《河南医学研究》2021年第11期1939-1943,共5页Henan Medical Research

基　　金：河南省高等学校重点科研项目(20B320049)。

摘　　要：目的探讨血清乳酸脱氢酶(S-LDH)对儿童急性淋巴细胞白血病(ALL)预后的预测价值。方法回顾性分析2015年1月至2019年1月郑州大学第一附属医院初治的446例ALL患儿的临床资料。利用受试者工作特征(ROC)曲线确定S-LDH预测ALL预后的最佳临界值,以临界值分为高S-LDH组和低S-LDH,组间不同临床特征患者构成比的比较采用χ^(2)检验。采用Kaplan-Meier法绘制生存曲线,通过log-rank检验对生存曲线的差异性进行分析。对各项影响因素先行单因素Cox回归分析,单因素分析中P<0.05的变量进行多因素Cox回归分析。结果(1)446例ALL患儿中,男284例(63.7%),女162例(36.3%),男女之比为1.75∶1,中位月龄60(7~168)个月。标危组137例(30.7%),中危组238例(53.4%),高危组71例(15.9%)。中位随访时间32个月,至随访结束存活361例(80.9%),死亡85例(19.1%)。(2)根据ROC曲线确定S-LDH的最佳临界值为545.5 U·L^(-1),曲线下面积(AUC)为0.783,敏感度为82.4%,特异度为61.8%。(3)高S-LDH组与低S-LDH组患儿在性别、激素预处理结果、第15天骨髓缓解状态、第33天骨髓缓解状态、第33天微小残留水平(MRD)等方面差异无统计学意义(P>0.05);高S-LDH组患儿月龄、白细胞计数、T系、中高危所占比例及复发率均高于低S-LDH组,差异有统计学意义(P<0.05)。(4)生存分析显示,低S-LDH组5 a累积生存率(90.4%)较高S-LDH组(63.1%)高(χ^(2)=54.398,P<0.05)。(5)多因素Cox回归分析表明,白细胞计数(HR=2.205,95%CI:1.320~3.683)、S-LDH(HR=3.972,95%CI:1.966~8.026)、复发(HR=10.907,95%CI:6.230~19.095)为影响急性淋巴细胞白血病患儿预后的独立危险因素。结论初诊S-LDH水平升高是ALL预后不良的因素之一,对评估ALL患儿预后有重要的临床价值。Objective To explore the predictive value of serum lactate dehydrogenase(S-LDH)on the prognosis of childhood acute lymphoblastic leukemia(ALL).Methods The clinical data of 446 ALL patients in the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2019 were retrospectively analyzed.Receiver operating characteristic(ROC)curve was used to determine the best cut-off value of S-LDH to predict the prognosis of ALL.The ALL patients were divided into high S-LDH group and low S-LDH group based on the cut-off value.Chi-square test was used to compare the composition ratio of different clinical features between two groups.Kaplan-Meier method was used to draw the survival curve,and the difference of the survival curve was analyzed by log-rank test.The univariate Cox regression analysis was performed for each influencing factor,and the variables with P<0.05 in the single-factor analysis were subjected to multivariate Cox regression analysis.Results(1)Among the 446 patients,284 cases(63.7%)were males,and 162 cases(36.3%)were females.The ratio of male to female was 1.75∶1.The median age was 60(7-168)months.There were 137(30.7%)cases in the standard-risk group,238(53.4%)cases in the intermediate-risk group,and 71(15.9%)cases in high-risk group.The median follow-up time was 32 months.By the end of the follow-up,361(80.9%)cases survived and 85(19.1%)cases died.(2)S-LDH optimal cut-off value obtained by the ROC curve was 545.5 U·L^(-1),and the area under curve(AUC)was 0.783.The sensitivity was 82.4%,and the specificity was 61.8%.(3)There were no statistical differences between high S-LDH group and low S-LDH group of patients in terms of gender,hormone pretreatment results,bone marrow remission status on day 15,bone marrow remission status on day 33,and minimal residual levels on day 33(P>0.05).The age,leukocyte counts,the proportion of T-ALL,medium or high risk and recurrence rate in high S-LDH group were higher than those in low S-LDH group(P<0.05).(4)Survival analysis revealed that the 5-year cumula

关 键 词：急性淋巴细胞白血病 乳酸脱氢酶 预后 累积生存率 

分 类 号：R733.71[医药卫生—肿瘤]