定量检测平均每日血小板增长量在B细胞急性淋巴细胞白血病患儿中的预后价值  

Prognostic Value of Average Daily Platelet Increase in Childhood B-cell Acute Lymphoblastic Leukemia Patients

作　　者：陈岚[1] 陈琪[1] 王月芳[1] CHEN Lan;CHEN Qi;WANG Yue-Fang(Department of Laboratory Medicine West China Second University Hospital Sichuan University,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University)Ministry of Education,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西第二医院检验科,出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《中国实验血液学杂志》2022年第2期413-417,共5页Journal of Experimental Hematology

摘　　要：目的:评价平均每日血小板增长量(average daily platelet amount increase, Ap)在CCCG-ALL-2015方案治疗的B细胞急性淋巴细胞白血病(B-ALL)患儿预后中的价值。方法:回顾性分析106例初发B-ALL患儿,标准化MRD检测方案检测化疗后d 19与d 46 MRD水平,Sysmex XE-2100检测血小板计数,Kaplan-Meier生存曲线分析患儿的无事件生存(EFS)率。结果:相关性分析显示PPC和TPR呈负相关(r_(s)=-0.519,P=0.021)。Ap>5.4×10^(9)/L组患儿3年EFS率为95.7%,明显高于Ap≤5.4×10^(9)/L组的79.5%(χ^(2)=5.236,P=0.035);多变量分析显示,Ap≤5.4×10^(9)/L是影响B-ALL患儿预后的独立危险因素(RR=3.978;95%CI:1.336-11.523,P=0.041)。若同时将MRD与Ap≤5.4×10^(9)/L作为候选变量,Ap≤5.4×10^(9)/L便失去了独立预后价值(RR=1.225;95%CI:0.892-13.696,P=0.089),d 19和/或d 46 MRD水平与Ap>5.4×10^(9)/L的相关性(χ^(2)=4.318,P=0.038)可解释这一现象。结论:Ap增生可反映B-ALL化疗效果,可用于B-ALL患儿疗效及预后的监测。Objective: To evaluate the prognosis value of average daily platelet amount increase in children with B-cell acute lymphoblastic leukemia(B-ALL) treated by CCCG-ALL-2015 regimen. Methods: 106 children with primary B-ALL were retrospective analyzed, standardized MRD test protocol was used to detect the MRD level(19 d and 46 d) after chemotherapy. The platelet count was measured by Sysmex XE-2100. Kaplan-Meier survival curve statistics was used to analyze the event free survival(EFS) rate of the children. Results: The trend of negative correlation existed between PPC and TPR(r_(s)=-0.519, P=0.021). The 3-year EFS rate of the patients in Ap>5.4×10^(9)/L group was 95.7%, which was significantly higher than those in Ap≤5.4×10^(9)/L group(79.5%)(χ^(2)=5.236, P=0.035);multivariate analysis showed that Ap≤5.4×10^(9)/L was the independent prognostic factor affecting survival of the patients(RR=3.978;95%CI: 1.336-11.523, P=0.041). With both MRD and Ap≤5.4×10^(9)/L as candidate variables, Ap≤5.4×10^(9)/L lost its independent prognostic value(RR=1.225;95%CI: 0.892-13.696, P=0.089), the correlation between d 19/d 46 MRD levels and Ap>5.4×10^(9)/L(χ^(2)=4.318, P=0.038) could explain the phenomenon. Conclusion: Ap can reflect the effect of B-ALL chemotherapy and can be used to monitor the curative effect and prognosis of B-ALL children.

关 键 词：急性B淋巴细胞白血病 流式细胞术 血小板 微小残留病 儿童 

分 类 号：R733.71[医药卫生—肿瘤]