构建重型β地中海贫血患者移植后出现巨细胞病毒感染风险的预测模型  

Construction of a prediction model for predicting the risk of cytomegalovirus infection after hematopoietic stem cell transplantation in patients with β-thalassemia major

作　　者：潘霖 谢燕妮 甘钊萍 肖鸿文 黄语妹[1] 杨高辉[1] 刘容容[1] 赖永榕[1] Pan Lin;Xie Yanni;Gan Zhaoping;Xiao Hongwen;Huang Yumei;Yang Gaohui;Liu Rongrong;Lai Yongrong(Department of Hematopathology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院血液内科,南宁530021

出　　处：《广西医科大学学报》2023年第4期657-662,共6页Journal of Guangxi Medical University

基　　金：国家自然科学基金资助项目(No.82060029,No.81960028);国家卫生健康委地中海贫血防治重点实验室(共建);广西地中海贫血防治重点实验室。

摘　　要：目的:构建列线图预测模型以预测重型β地中海贫血患者移植后出现巨细胞病毒(CMV)感染的风险,评估模型的预测价值。方法:收集2020年7月至2022年6月在广西医科大学第一附属医院血液内科接受造血干细胞移植的重型β地中海贫血患者的临床资料,以出现CMV感染为结局分为感染组和未感染组,通过独立样本t检验、非参数检验、卡方检验、LASSO回归方法确定纳入列线图模型的预测指标。通过受试者工作特征曲线(ROC)、校准曲线、C指数和决策曲线分析评估和验证模型的价值,并通过Bootstrap方法进行内部验证。结果:年龄、HLA配型、环孢素A、血清铁蛋白、CD34、急性移植物抗宿主病(aGVHP)是构建重型β地中海贫血移植后出现CMV感染的列线图模型的预测指标。列线图的C指数为0.682(95%CI:61.0%~75.4%),内部验证的C指数为0.644,ROC曲线下面积0.682,决策曲线分析结果为0.09~0.83。结论:首次构建以年龄、HLA配型、环孢素A、血清铁蛋白、CD34、急性移植物抗宿主病为评分依据的列线图预测模型,该模型预测重型β地中海贫血患者移植后出现CMV感染风险的效果良好,有利于优化患者的临床诊疗,更好地提高患者的生活质量。Objective:To construct a nomogram prediction model for predicting the risk of cytomegalovirus(CMV)infection in patients with β-thalassemia major after hematopoietic stem cell transplantation(HSCT),and to evaluate its predictive value.Methods:Clinical data of patients with β-thalassemia major undergoing HSCT in the Department of Hematopathology of the First Affiliated Hospital of Guangxi Medical University from July 2020 to June 2022 were collected and divided into infected group and non-infected group according to the outcome of CMV infection.Independent samples t-test,nonparametric test,chi-square test,LASSO regression method were used to determine the prediction predictors included in the nomogram model.The value of the model was evaluated and verified by receiver operating characteristic curve(ROC),calibration curve,C-index and decision curve analysis(DCA),and the Bootstrap method was used for internal validation.Results:Age,HLA matching,cyclosporin A,serum ferritin,CD34 and acute graft-versus-host disease(aGVHD)were predictive factors of constructing the nomogram model for CMV infection after HSCT in patients with severe β-thalassemia.The C-index of the nomogram was 0.682(95%CI:0.610-0.754),the C-index calculated by internal validation was 0.644,the area under the ROC curve was 0.682,and the result of DCA was 0.09-0.83.Conclusion:The nomogram model is constructed based on age,HLA matching,cyclosporin A,serum ferritin,CD34 and aGVHD for the first time.The model is effective in predicting the risk of CMV infection in patients with β thalassemia major after HSCT,which was conducive to optimizing clinical diagnosis and treatment of patients and improving the quality of life of patients.

关 键 词：重型Β地中海贫血 造血干细胞移植 巨细胞病毒感染 列线图 

分 类 号：R556[医药卫生—血液循环系统疾病]