外周血淋巴细胞计数对成人噬血细胞综合征患者死亡风险的预测价值  

Predictive value of peripheral blood absolute lymphocyte count for mortality risk in adult patients with hemophagocytic lymphohistiocytosis

作　　者：董宁[1] 周军 谢梦晓 徐华国[1] DONG Ning;ZHOU Jun;XIE Mengxiao;XU Huaguo(Department of Clinical Laboratory,Jiangsu Provincial People′s Hospital/Branch of National Clinical Research Center for Laboratory Medicine,Nanjing,Jiangsu 210029,China)

机构地区：[1]江苏省人民医院检验科/国家医学检验临床医学研究中心分中心,南京210029

出　　处：《重庆医学》2022年第4期574-578,583,共6页Chongqing medicine

基　　金：国家自然科学基金项目(82101902);江苏省自然科学基金项目(SBK2020042441)。

摘　　要：目的评估入院外周血淋巴细胞计数(ALC)对成人噬血细胞综合征(HLH)患者6个月死亡风险的预测价值。方法回顾性收集2012年1月至2018年6月入住本院的171例初诊成人HLH患者首次入院的临床和实验室资料。首先依据患者初次诊断为HLH后6个月内的生存状态,利用受试者工作特征(ROC)曲线确定ALC的最佳界值,将患者分为高ALC组和低ALC组,比较两组患者间的差异;再经过单因素和多因素logistic回归分析确定影响HLH患者6个月死亡风险的独立因素;最后通过Kaplan-Meier生存曲线进一步验证ALC与患者生存时间的关系。结果取ALC最佳界值0.51×10^(9)/L时,ROC曲线下面积为0.740(0.668,0.804)。低ALC组(≤0.51×10^(9)/L)和高ALC组(>0.51×10^(9)/L)患者铁蛋白大于500μg/L者百分比、中性粒细胞计数、血小板计数、血红蛋白、尿素氮(UREA)和肌酐(CREA)水平有明显差异(P<0.05),且低ALC组死亡率明显高于高ALC组(77.8%vs.34.3%,P<0.05)。多因素logistic回归分析结果显示,ALC、血小板计数和UREA是HLH患者6个月死亡风险的独立影响因素。Kaplan-Meier生存曲线表明,在HLH及其亚类[感染相关的HLH(IAHS)、肿瘤相关的HLH(MAHS)、混合病因的HLH(Mixed)]患者中,高ALC组和低ALC组6个月生存期有明显差异(P<0.05)。结论ALC对成人HLH患者6个月死亡风险的预测具有重要价值。Objective To assess the predictive value of peripheral blood absolute lymphocyte count(ALC)on admission for 6-month mortality in adult patients with hemophagocytic lymphohistiocytosis(HLH).Methods The clinical and laboratory data on admission of 171 adult patients with newly diagnosed HLH from January 2012 to June 2018 were retrospectively collected.Firstly,according to the survival status of patients within 6 months after the initial diagnosis of HLH,the optimal cut-off value of ALC was determined by the receiver operating characteristic(ROC)curve.Then,the patients were divided into the high ALC group and the low ALC group,and the differences between the two groups were compared.Secondly,univariate and multivariate logistic analysis was conducted to determine the independent factors affecting the 6-month risk of mortality of HLH patients.Finally,the Kaplan-Meier survival curve was used to further verify the relationship between ALC and survival time.Results When the optimal cut-off value of ALC was 0.51×10^(9)/L,the area under the ROC curve was 0.740(0.668,0.804).There were statistically significant differences between the low ALC group(≤0.51×10^(9)/L)and the high ALC group(>0.51×10^(9)/L)in the percentage of patients with ferritin>500μg/L,neutrophil count,platelet count,levels of hemoglobin,urea nitrogen(UREA)and creatinine(CREA)(P<0.05),and the mortality rate in the low ALC group was significantly higher than that in the high ALC group(77.8%vs.34.3%,P<0.05).The results of multivariate logistic regression analysis showed that ALC,platelets count and UREA were independent influencing factors of 6-month riskof mortality in patients with HLH.Kaplan-Meier survival curve showed that there was a significant difference in 6-month survival time between the low ALC group and the high ALC group in patients with HLH and its subtypes,including infection-associated HLH(IAHS),tumor-associated(MAHS),and mixed etiology HLH(Mixed)(P<0.05).Conclusion ALC is of great value in predicting 6-month risk of mortality in adult pa

关 键 词：噬血细胞综合征 淋巴细胞计数 预后 成人 

分 类 号：R593.2[医药卫生—内科学]