细胞角蛋白检测对儿童ALL药物性肝损伤预测价值  

Value of cytokeratins in predicting drug-induced liver injury in children with acute lymphoblastic leukemia

作　　者：郭佳 周彦生 李培岭[1] 赵东菊[1] GUO Jia;ZHOU Yan-sheng;LI Peiling;ZHAO Dongju(Department of Pediatrics,The First Affiliated Hospital of Xinxiang Medical College,Xin-xiang 453100,China)

机构地区：[1]新乡医学院第一附属医院儿科,河南新乡453100 [2]新乡医学院第一附属医院感染控制管理部,河南新乡453100

出　　处：《青岛大学学报（医学版）》2024年第1期95-99,共5页Journal of Qingdao University(Medical Sciences)

基　　金：河南省医学科技攻关计划项目(LHGJ20220615)。

摘　　要：目的探究血清细胞角蛋白18-M30(CK18-M30)和18-M65(CK18-M65)对儿童急性淋巴细胞白血病(ALL)治疗后发生药物性肝损伤(DILI)的预测价值。方法2019年3月—2022年2月,新乡医学院第一附属医院收治ALL病儿66例,依据DILI分为观察组49例(发生)和对照组17例(未发生),观察组依据DILI病情分为轻度、中度和重度亚组。收集病儿相关临床资料,检测血清CK18-M30和CK18-M65活力。分析发生DILI的影响因素及血清CK18-M30和CK18-M65表达对并发DILI的预测价值。结果观察组血清CK18-M30和CK18-M65活力高于对照组(t=14.230、12.735,P<0.05)。DILI病情越严重,血清CK18-M30和CK18-M65活力越高(F=20.122、5.551,P<0.05)。ALL疾病危险程度、感染、输血、血清CK18-M30和CK18-M65活力等均为ALL病儿发生DILI的危险因素(OR=1.869~2.866,95%CI=(1.205~1.799)~(2.773~4.257),P<0.05),保肝药应用则为发生DILI的保护因素(OR=0.522,95%CI=0.395~0.670,P<0.05)。血清CK18-M30和CK18-M65预测ALL病儿发生DILI的受试者工作特征曲线下面积(AUC)分别为0.739和0.699,两者联合预测效能更高。结论ALL病儿血清CK18-M30和CK18-M65活力可作为发生DILI的预测指标。Objective To investigate the value of serum cytokeratin 18-M30(CK18-M30)and cytokeratin 18-M65(CK18-M65)in predicting drug-induced liver injury(DILI)after treatment in children with acute lymphoblastic leukemia(ALL).Methods A total of 66 children with ALL who were admitted to The First Affiliated Hospital of Xinxiang Medical University from March 2019 to February 2022 were enrolled,and according to the presence or absence of DILI,they were divided into observation group(49 children with DILI)and control group(17 children without DILI).The observation group was further divided into mild,moderate,and severe subgroups according to the severity of DILI.Related clinical data were collected from all children,and the activities of serum CK18-M30 and CK18-M65 were measured.The influencing factors for the onset of DILI were analyzed,as well as the value of serum CK18-M30 and CK18-M65 in predicting the development of DILI.Results Compared with the control group,the observation group had significantly higher activities of serum CK18-M30 and CK18-M65(t=14.230,12.735;P<0.05),and the activities of serum CK18-M30 and CK18-M65 increased with the increase in the severity of DILI(F=20.122,5.551;P<0.05).The severity of ALL,infection,blood transfusion,and the activities of serum CK18-M30 and CK18-M65 were risk factors for DILI in children with ALL(OR=1.869-2.866,95%CI=1.205-1.799 to 2.773-4.257,P<0.05),while the use of liver-protecting drugs was a protective factor against DILI(OR=0.522,95%CI=0.395-0.670,P<0.05).Serum CK18-M30 and CK18-M65 had an area under the ROC curve of 0.739 and 0.699,respectively,and the combination of the two had a better predictive efficacy.Conclusion The activities of serum CK18-M30 and CK18-M65 can be used as predictive factors for the development of DILI in children with ALL.

关 键 词：前体细胞淋巴母细胞白血病淋巴瘤 药物疗法 联合 化学性与药物性肝损伤 角蛋白18 LOGISTIC模型 ROC曲线 

分 类 号：R733.73[医药卫生—肿瘤] R341.26[医药卫生—临床医学]