经DCAG方案化疗后AML患者血清HOXA9、PCⅢ、SE-CAD水平的变化及其与预后的关系  

Changes in Serum HOXA9,PCⅢ,SE-CAD Levels in AML Patients after Chemotherapy with DCAG Regimen and Their Relationship with Prognosis

作　　者：苏欢 文宁 向婕 王能勇[1] SU Huan;WEN Ning;XIANG Jie;WANG Neng-Yong(Department of Clinical Laboratory,Guangyuan Central Hospital,Guangyuan 628400,Sichuan Province,China)

机构地区：[1]广元市中心医院检验科,四川广元628400

出　　处：《中国实验血液学杂志》2024年第4期987-992,共6页Journal of Experimental Hematology

基　　金：四川省卫生健康科研课题(19PJ208)。

摘　　要：目的:探讨急性髓系白血病(AML)患者采用DCAG方案化疗后血清同源盒基因A9(HOXA9)、可溶性E钙黏蛋白(SE-CAD)及Ⅲ型前胶原蛋白(PCⅢ)水平的变化及其与预后的关系。方法:回顾性分析2018年3月至2021年12月经本院确诊并收治的80例复发难治性AML患者的资料,按照治疗方案不同将其分为DCAG组(n=40)与CAG组(n=40),对比治疗前后各组的临床疗效及HOXA9、SE-CAD、PCⅢ水平的变化;另按照临床疗效将所有患者分为缓解组(n=58)与未缓解组(n=22),通过单因素和多因素分析影响AML患者预后的危险因素;采用ROC曲线分析HOXA9、SE-CAD、PCⅢ三项单一指标及三者联合对预后的预测效能。结果:相比于治疗前,DCAG组与CAG组患者在治疗后的HOXA9、SE-CAD、PCⅢ水平均有所下降,但DCAG组患者各指标的改善效果明显优于CAG组,且DCAG组患者在治疗后的临床疗效显著优于CAG组(均P<0.05);多因素分析结果显示,骨髓原始细胞比率、HOXA9 m RNA、SE-CAD及PCⅢ水平升高是影响AML患者化疗疗效的独立危险因素(均P<0.05);ROC曲线分析显示,HOXA9 m RNA、SE-CAD及PCⅢ联合能够有效预测AML预后情况,其敏感度为84.80%、特异度为88.20%。结论:应用DCAG的化疗方案能够显著改善AML患者的HOXA9 m RNA、SE-CAD及PCⅢ水平;且这三项指标作为影响AML患者预后的危险因素,通过联合检测能够对AML患者的预后情况进行有效预测。Objective:To investigate the changes in serum homeobox A9(HOXA9),soluble E-cadherin(SE-CAD)and typeⅢprocollagen(PCⅢ)levels in acute myeloid leukemia(AML)patients after chemotherapy with DCAG regimen and their relationship with prognosis.Methods:The clinical data of 80 patients with relapsed/refractory AML diagnosed and treated in our hospital from March 2018 to December 2021 were retrospectively analyzed.According to different treatment regimen,the patients were divided into DCAG group(n=40)and CAG group(n=40).The clinical efficacy and changes of HOXA9,SE-CAD and PCⅢlevels before and after treatment were compared.In addition,all patients were divided into remission group(n=58)and non-remission group(n=22)according to the clinical efficacy.Univariate and multivariate analyses were performed to analyze the risk factors affecting the prognosis of AML patients.The predictive efficacy of the three single indicators,HOXA9,SE-CAD,and PC III,and their combination on prognosis was analyzed.Results:Compared with before treatment,the levels of HOXA9,SE-CAD and PCⅢin both the DCAG and CAG groups were decreased after treatment,and the improvement of each indicator and the clinical efficacy in the DCAG group were significantly better than those in the CAG group(all P<0.05).Multivariate analysis showed that increased bone marrow blast count,HOXA9 mRNA,SE-CAD and PCⅢlevels were independent risk factors affecting the efficacy of chemotherapy in AML patients(all P<0.05).ROC curves showed that the combination of HOXA9 mRNA,SE-CAD and PCIII could effectively predict the prognosis of AML patients,with a sensitivity of 84.80%and a specificity of 88.20%.Conclusion:DCAG regimen can significantly improve the levels of HOXA9 mRNA,SE-CAD and PCⅢin AML patients,these three indicators are all independent risk factors affecting the prognosis of AML patients,and the combination of the three indicators can effectively predict the prognosis of the patients.

关 键 词：急性髓系白血病 同源盒基因A9 可溶性E钙黏蛋白 Ⅲ型前胶原蛋白 DCAG化疗方案 

分 类 号：R733.71[医药卫生—肿瘤]