血清乳酸脱氢酶、β2微球蛋白、铁蛋白联合改良WHO预后积分系统预测骨髓增生异常综合征预后不良的价值  

Value of serum lactate dehydrogenase,β2 microglobulin and ferritin combined with modified WHO-based Prognostic Scoring System in predicting poor prognosis of myelodysplastic syndrome

作　　者：万姜维[1] 成东茹 王涛[1] 高萍[1] WAN Jiangwei;CHENG Dongru;WANG Tao;GAO Ping(Department of Hematology and Oncology,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,450000)

机构地区：[1]河南中医药大学第一附属医院血液肿瘤科,河南郑州450000

出　　处：《实用临床医药杂志》2024年第5期79-84,共6页Journal of Clinical Medicine in Practice

基　　金：河南省中医药科学研究专项(2019JDZX2082);第七批全国老中医药专家学术经验继承工作指导项目(20230522);河南省中医药青苗人才项目(豫卫中医函〔2021〕16号)。

摘　　要：目的探讨血清乳酸脱氢酶(LDH)、β2微球蛋白(β2-MG)、铁蛋白(SF)联合改良WHO预后积分系统(WPSS)评分对骨髓增生异常综合征(MDS)预后不良的预测价值。方法选取110例MDS患者作为研究对象,均检测血清LDH、β2-MG、SF水平。根据生存情况将患者分为病死组与存活组,比较2组血清LDH、β2-MG、SF水平和改良WPSS评分。分析MDS预后不良的危险因素及血清LDH、β2-MG、SF水平和改良WPSS评分单独及联合对MDS预后不良的预测价值。结果MDS预后不良发生率为40.20%(41/102)。病死组血清LDH、β2-MG、SF、改良WPSS评分和染色体核型预后不良比率均高于存活组,差异有统计学意义(P<0.05)。Cox回归模型分析结果显示,血清LDH、β2-MG、SF水平和改良WPSS评分升高、染色体核型预后不良是MDS预后不良的危险因素(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,血清LDH、β2-MG、SF水平联合改良WPSS评分预测MDS预后不良的灵敏度和曲线下面积(AUC)分别为95.12%、0.918,均显著高于各指标单独预测(P<0.05)。结论血清LDH、β2-MG、SF水平和改良WPSS评分对MDS预后不良均具有一定的预测价值,但4项指标联合预测价值更高。Objective To investigate the value of serum lactate dehydrogenase(LDH),β2-microglobulin(β2-MG)and serum ferritin(SF)combined with the modified WHO-based Prognostic Scoring System(WPSS)score in predicting poor prognosis of patients with myelodysplastic syndrome(MDS).Methods A total of 110 patients with MDS were selected as the research objects,and serum levels of LDH,β2-MG and SF were detected.The patients were divided into death group and survival group according to their survival status,and the serum levels of LDH,β2-MG and SF as well as the modified WPSS score were compared between the two groups.The risk factors for poor prognosis in MDS patients and the predictive values of serum LDH,β2-MG,SF and modified WPSS score alone and their combination for poor prognosis in MDS patients were analyzed.Results The incidence of poor prognosis in MDS patients was 40.20%(41/102).The serum levels of LDH,β2-MG and SF,the modified WPSS score,and the ratio of adverse karyotype prognosis in the death group were significantly higher than those in the survival group(P<0.05).The results of Cox regression model analysis showed that elevated serum levels of LDH,β2-MG and SF,elevated modified WPSS score,and adverse karyotype prognosis were risk factors for poor prognosis in MDS patients(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that the combination of serum LDH,β2-MG,SF levels and modified WPSS score had a sensitivity of 95.12%and an area under the curve(AUC)of 0.918 for predicting poor prognosis in MDS patients,which were significantly higher than those of each indicator alone(P<0.05).Conclusion Serum LDH,β2-MG,SF levels and modified WPSS score have certain predictive value for poor prognosis in MDS patients,but the combined prediction value of the four indicators is higher.

关 键 词：乳酸脱氢酶 Β2微球蛋白 铁蛋白 改良WHO预后积分系统 骨髓增生异常综合征 预后 

分 类 号：R551.3[医药卫生—血液循环系统疾病] R446.11[医药卫生—内科学] R556.5[医药卫生—临床医学]