Auer小体对初诊非M3型急性髓细胞白血病患者预后的影响  

Effects of Auer rod on prognosis in patients with freshly-diagnosed non-M3 type acute myeloid leukemia

作　　者：黄雅睿 黄兴琴 黄祥涛 罗承昕 徐双年 陈洁平 HUANG Yarui;HUANG Xingqin;HUANG Xiangtao;LUO Chengxin;XU Shuangnian;CHEN Jieping(Center of Hematology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院血液病中心,重庆400038

出　　处：《陆军军医大学学报》2022年第3期224-230,共7页Journal of Army Medical University

基　　金：国家自然科学基金青年科学基金(81800172)。

摘　　要：目的探究Auer小体对初诊非M3型急性髓系白血病(acute myeloid leukemia,AML)预后的影响。方法采用回顾性队列研究设计,纳入本中心2012年1月至2019年12月收治的154例初诊非M3型AML患者病历资料,根据骨髓原始细胞有无Auer小体分为Auer小体阳性组和Auer小体阴性组,随访数据通过电子病历或打电话获取,比较两组患者临床资料的差异,包括性别、年龄、白细胞(white blood cell,WBC)计数、血小板(platelet,PLT)计数、血红蛋白(hemoglobin,Hb)、乳酸脱氢酶(lactate dehydrogenase,LDH)、法美英协作组(French-American-British,FAB)分型、骨髓原始细胞比例及危险度分层等;通过Kaplan-Meier法和COX多因素回归模型比较两组时间事件结局的差异。结果与Auer小体阴性组AML患者相比,阳性组在FAB分型中的M2型比例较高、M5型比例较低(P<0.001,P=0.005),且骨髓原始细胞比例显著降低(P<0.001)、WT1基因突变频率明显增高(P=0.006),病死率显著降低(P=0.008)。生存分析结果显示,阳性组患者总生存率(overall survival,OS)高于阴性组(P=0.010)。多因素COX回归分析表明,Auer小体是OS的独立影响因素(HR=0.298,95%CI:0.104~0.853,P=0.024)。结论Auer小体是影响AML的独立预后因素,对AML的预后具有较好的预测价值。Objective To investigate the effects of Auer rod on the prognosis of newly-diagnosed non-M3 type acute myeloid leukemia(AML).Methods A retrospective cohort study was performed on 154 patients initially diagnosed as non-M3 type AML in our center from January 2012 to December 2019.According to the presence or absence of Auer rod in the bone marrow blasts,the patients were divided into Auer rod positive and negative groups.Their follow-up data were obtained from medical records and through telephone conversations with the enrolled patients.Clinical data were compared between the 2 groups,including gender,age,white blood cell(WBC)count,platelet(PLT)count,hemoglobin(Hb),lactate dehydrogenase(LDH),French-American-British(FAB)classification,percentage of blast cells in bone marrow,and cytogenetic risk stratification.Kaplan-Meier survival analysis and multivariate COX regression model were used to analyze the difference in outcome of time-events between the 2 groups.Results As compared with the Auer rod negative group,the Auer rod positive group had higher proportion of M2 type(P<0.001)but lower proportion of M5 type(P=0.005)in FAB classification,lower percentage of bone marrow blasts(P<0.001),higher mutation frequency of WT1 gene(P=0.006),and lower mortality rate(P=0.008).The overall survival(OS)was significantly longer in the Auer rod positive group than the negative group(P=0.01).Multivariate COX regression analysis showed that Auer rod was an independent influencing factor for OS(HR=0.298,95%CI:0.104~0.853,P=0.024).Conclusion Auer rod is an independent prognostic factor of AML,and presents good prognostic value.

关 键 词：AUER小体 急性髓系白血病 预后 

分 类 号：R557[医药卫生—血液循环系统疾病]