外周血自然杀伤细胞TIM-3水平与急性髓系白血病患儿预后的相关性  

Correlation between TIM-3 level and prognosis of children with acute myeloid leukemia

作　　者：屈虹[1] 李彦清 刘玉[1] QU Hong;LI Yan-qing;LIU Yu(Department of Pediatrics,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,XinjiangUygur Autonomous Region 830054,China)

机构地区：[1]新疆医科大学第一附属医院儿科,新疆维吾尔自治区乌鲁木齐830054

出　　处：《中华实用诊断与治疗杂志》2021年第11期1144-1147,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：新疆维吾尔自治区自然科学基金(2017D01C206)。

摘　　要：目的观察急性髓系白血病(acute myeloid leukemia,AML)患儿外周血自然杀伤(natural killer,NK)细胞T细胞免疫球蛋白黏蛋白分子-3(T cell immunoglobulin mucin-3,TIM-3)表达变化,探讨其与AML患儿预后的关系。方法AML患儿208例,入院次日检测骨髓CD96、CD123表达及外周血NK细胞TIM-3表达,对危险度分级低、中危患儿采用DAE(柔红霉素+阿糖胞苷+依托泊苷)方案诱导缓解治疗,高危患儿采用IA(去甲氧柔红霉素+阿糖胞苷)方案诱导缓解治疗,完全缓解后均采用DAE方案巩固治疗。随访8~12个月,根据预后将208例患儿分为预后不良组和预后良好组,比较2组年龄,性别,病程,危险度分级,合并骨髓增生异常综合征比率,白细胞计数,骨髓CD96、CD123及外周血NK细胞TIM-3表达;多因素logistic回归分析AML患儿预后不良的影响因素;绘制ROC曲线,评估外周血NK细胞TIM-3预测AML患儿预后不良的价值。结果208例患儿中186例预后良好,22例预后不良。预后不良组危险度分级高危比率(59.09%),骨髓CD96(36.36%)、CD123(68.18%)阳性表达率及外周血NK细胞TIM-3表达[(45.98±7.42)%]均高于预后良好组[29.57%、11.29%、38.71%、(37.15±6.19)%](P<0.05),年龄、性别比例、病程、合并骨髓增生异常综合征比率、白细胞计数与预后良好组比较差异均无统计学意义(P>0.05)。危险度分级高危(OR=3.440,95%CI:1.390~8.516,P=0.008)、骨髓CD96阳性表达(OR=4.490,95%CI:1.685~11.965,P=0.003)、骨髓CD123阳性表达(OR=3.393,95%CI:1.320~8.724,P=0.011)及外周血NK细胞TIM-3表达(OR=1.176,95%CI:1.096~1.262,P<0.001)是AML患儿预后不良的影响因素。外周血NK细胞TIM-3表达以39.01%为最佳截断值,预测AML患儿预后不良的AUC为0.832(95%CI:0.753~0.910,P<0.001),灵敏度为83.3%,特异度为72.7%。结论AML患儿外周血NK细胞TIM-3表达升高与预后不良有关,其预测AML患儿预后不良有一定价值。Objective To observe the expression of T cell immunoglobulin mucin-3(TIM-3)in peripheral blood natural killer(NK)cells of children with acute myeloid leukemia(AML),and to explore its correlation with the prognosis of children with AML.Methods Totally 208 children with AML were detected the expressions of CD96 and CD123 in bone marrow as well as TIM-3 in peripheral blood NK cells on the second day after admission.The children in low and medium risk were treated with DAE regimen(daunorubicin+cytarabine+etoposide)for induced remission,and the children in high risk were treated with IA regimen(noroxydaunorubicin+cytarabine)for induced remission,followed by DAE regimen for consolidation after complete remission.After follow-up for 8 to 12 months,208 children were divided into poor prognosis group and good prognosis group,and the clinical data were compared between two groups,including age,gender,course of disease,risk grade,percentage of myelodysplastic syndrome,white blood cell count,and the expressions of CD96 and CD123 in bone marrow as well as TIM-3 in peripheral blood NK cells.Multivariate logistic regression analysis was used to study the influencing factors of poor prognosis in children with AML.ROC curve was drawn to assess the value of TIM-3 to the prediction of poor prognosis of children with AML.Results In 208 children with AML,186 got a good prognosis and 22 got a poor prognosis.The high-risk grade rate,the positive rates of bone marrow CD96 and CD123 and the expression of TIM-3 in peripheral blood were higher in poor prognosis group[59.09%,36.36%,68.18%,(45.98±7.42)%]than those in good prognosis group[29.57%,11.29%,38.71%,(37.15±6.19)%](P<0.05),and there were no significant differences in the age,gender ratio,course of disease,percentage of myelodysplastic syndrome and white blood cell count between two groups(P>0.05).High-risk grade(OR=3.440,95%CI:1.390-8.516,P=0.008),positive expression of bone marrow CD96(OR=4.490,95%CI:1.685-11.965,P=0.003),positive expression of bone marrow CD123(OR=3.393,95%CI:1.3

关 键 词：急性髓系白血病 自然杀伤细胞 T细胞免疫球蛋白黏蛋白分子-3 预后 儿童 

分 类 号：R733.71[医药卫生—肿瘤]