系统性炎症指标评估儿童淋巴瘤自体外周血干细胞移植术后生存的价值  

Value of systemic inflammatory markers in evaluating the survival of children with lymphoma after autologous peripheral blood stem cells transplantation

作　　者：潘晓丽 马薇娜[1] 刘玉[1] PAN Xiaoli;MA Weina;LIU Yu(the First Department of Pediatrics,the First Affiliated Hospital of Xinjiang Medical University,Xinjiang Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院儿内一科,新疆乌鲁木齐830054

出　　处：《中国妇幼健康研究》2023年第1期85-91,共7页Chinese Journal of Woman and Child Health Research

基　　金：新疆维吾尔自治区自然科学基金资助项目(2019D01C228)。

摘　　要：目的探讨系统性炎症指标在评估儿童淋巴瘤自体外周血干细胞移植(APBSCT)术后生存情况中的价值。方法回顾性分析2013年1月至2017年6月在新疆医科大学第一附属医院接受APBSCT术治疗的56例儿童淋巴瘤患儿的临床资料,通过中性粒细胞与淋巴细胞比值(NLR)预测儿童淋巴瘤患儿APBSCT术后生存情况的ROC曲线,获得NLR的最佳诊断截点,并以NLR最佳诊断截点将患儿分为NLR≥2.25组(38例)与NLR<2.25组(18例),采用Kaplan-Meier生存曲线分析方法,比较两组患儿术后疾病无进展生存率和总生存率。结果56例儿童淋巴瘤患儿APBSCT术后1年、3年、5年的疾病无进展生存率分别为91.07%、71.43%、67.85%,术后1年、3年、5年的总生存率分别为94.64%、83.93%、71.43%。多因素Cox分析显示,临床分期、淋巴瘤国际预后评分(IPI)、移植前状态、NLR均为淋巴瘤患儿APBSCT术后疾病进展和死亡的独立预测因素。临床分期Ⅲ~Ⅳ期淋巴瘤患儿术后5年内疾病进展的风险是临床分期Ⅰ~Ⅱ期的2.124倍(95%CI:1.691~2.688,P=0.021),临床分期Ⅲ~Ⅳ期患儿术后5年内死亡的风险是临床分期Ⅰ~Ⅱ期的1.754倍(95%CI:1.333~2.234,P=0.025);IPI评分>2分淋巴瘤患儿术后5年内疾病进展的风险是IPI评分≤2分的2.322倍(95%CI:1.783~3.234,P=0.017),IPI评分>2分患儿术后5年内死亡的风险是IPI评分≤2分的1.654倍(95%CI:1.122~2.426,P=0.023);移植前病情部分缓解淋巴瘤患儿术后5年内疾病进展的风险是移植前病情完全缓解的2.423倍(95%CI:1.822~3.183,P=0.009),移植前病情部分缓解患儿术后5年内死亡的风险是移植前病情完全缓解的2.063倍(95%CI:1.765~2.885,P=0.010);移植前NLR每增加1个单位,淋巴瘤患儿术后5年内疾病进展的风险增加0.785倍(95%CI:1.244~2.256,P=0.041),移植前NLR每增加1个单位,患儿术后5年内死亡的风险增加0.571倍(95%CI:1.144~2.083,P=0.046)。以NLR值为2.25作为最佳诊断截点预测儿童淋巴瘤患儿APBSCObjective To explore the value of systemic inflammatory markers in evaluating the survival of children with lymphoma after autologous peripheral blood stem cell transplantation(APBSCT).Methods The clinical data of 56 children with lymphoma who underwent APBSCT in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to June 2017 were retrospectively analyzed,the receiver operating characteristic(ROC)curve for predicting the survival of children with lymphoma after APBSCT was obtained by neutrophil lymphocyte ratio(NLR),and the best diagnostic cut-off point of NLR was obtained.Based on the best diagnostic cut-off point of NLR,the children were divided into NLR≥2.25 group(38 cases)and NLR<2.25 group(18 cases),Kaplan Meier survival curve analysis was used to compare the progression free survival rate and overall survival rate between the two groups.Results The 1-year,3-year and 5-year progression free survival rates of 56 children with lymphoma after APBSCT were 91.07%,71.43%and 67.85%,respectively,the 1-year,3-year and 5-year overall survival rates were 94.64%,83.93%and 71.43%,respectively.Multivariate Cox analysis showed that clinical stage,lymphoma international prognostic index(IPI),pre transplant status,and NLR were independent predictors of progression and death in children with lymphoma after APBSCT.The children with clinical stageⅢ-Ⅳlymphoma had 2.124 times higher risk of disease progression within 5 years after operation than that in clinical stageⅠ-Ⅱ(95%CI:1.691-2.688,P=0.021),the children with clinical stageⅢ-Ⅳlymphoma had 1.754 times higher risk of death within 5 years after operation than that in clinical stageⅠ-Ⅱ(95%CI:1.333-2.234,P=0.025);the children with IPI score>2 had 2.322 times higher risk of disease progression within 5 years after operation than that with IPI score≤2(95%CI:1.783-3.234,P=0.017),and the children with IPI score>2 had 1.654 times higher risk of death within 5 years after operation than that with IPI score≤2(95%CI:1.122-2.426,P=0.023);

关 键 词：系统性炎症指标 儿童 淋巴瘤 自体外周血干细胞移植 最佳诊断截点 

分 类 号：R179[医药卫生—妇幼卫生保健] R73[医药卫生—公共卫生与预防医学]