诱导化疗时外周血原始细胞清除时间和初诊时白蛋白水平与急性髓系白血病患者基因突变及预后之间的关系  

Relations between Peripheral Blood Blast Clearance Time and Albumin Level at Initial Diagnosis during Induction Chemotherapy and Genetic Mutations and Prognosis in Patients with Acute Myeloid Leukemia

作　　者：张瑞婷 阎斌[1] 李祖燕 孙金敏 姚锦[1] ZHANG Ruiting;YAN Bin;LI Zuyan;SUN Jinmin;YAO Jin(Dept.of Oncology,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650033,China)

机构地区：[1]昆明医科大学第二附属医院肿瘤科,云南昆明650033

出　　处：《昆明医科大学学报》2024年第8期117-124,共8页Journal of Kunming Medical University

基　　金：昆明医科大学第二附属医院研究生创新基金资助项目(2023S332)。

摘　　要：目的 探讨诱导化疗时外周血原始细胞清除(PBBC)时间和初诊时白蛋白(ALB)水平与急性髓系白血病(AML)患者基因突变及预后之间的关系。方法 收集昆明医科大学第二附属医院2017年1月至2023年5月初诊的175例AML患者的临床资料进行回顾性分析,采用ROC曲线确定PBBC的最佳临界值为6.5 d,PBBC≤6.5 d划分为外周血原始细胞清除短时间组(EBC),PBBC> 6.5 d分为外周血原始细胞清除长时间组(DBC);以PBBC和初诊时ALB建立简易预后模型,可以将患者划分为a、b、c 3组,a组(PBBC≤6.5 d、ALB>34.45 g/L,无危险因素),b组(PBBC> 6.5 d、ALB> 34.45 g/L或PBBC≤6.5 d、ALB≤34.45 g/L,1个危险因素),c组(PBBC> 6.5 d、ALB≤34.45 g/L,2个危险因素),对3组患者各基因突变情况及OS进行比较;采用t检验和卡方检验或秩和检验评估各种参数的差异性,Kaplan-Meier法进行生存分析。结果 对影响预后的因素进行COX回归分析显示PBBC和ALB是影响预后的独立因素,差异存在统计学意义(P <0.05);对abc 3组的OS进行组间比较发现,3组中位OS分别为未达到、1.86 a和0.93 a(a组vs b组,P <0.001;a组vs c组,P <0.001;b组vs c组,P=0.001),差异具有统计学意义,得出无危险因素组的OS和PFS均优于1~2个危险因素者。发现3组间CEBPA双突变和NPM1基因突变无统计学意义(P> 0.05),但C-KIT基因突变有统计学意义(P <0.05)。结论 PBBC和ALB是AML患者预后的独立危险因素,以PBBC和ALB组成的简易预后模型可以为精准化、个体化诱导化疗方案的选择提供依据,为判断初诊AML患者的基因突变及预后提供参考。Objective To investigate the relationship between peripheral blood blast clearance(PBBC)time during induction chemotherapy and albumin(ALB)level at diagnosis and genetic mutation and prognosis in acute myeloid leukemia patients(AML).Methods Clinical data of 175 AML patients initially diagnosed from January 2017 to May 2023 at the Second Affiliated Hospital of Kunming Medical University were collected for a retrospective analysis.ROC curve was used to determine the optimal cut-off value of PBBC as 6.5 days.PBBC≤6.5 days were classified as the Peripheral Blood Primitive Blood Cell Short-Term Clearance Group(EBC),and PBBC>6.5 days were classified as the Peripheral Blood Primitive Blood Cell Long-Term Clearance Group(DBC).A simple prognostic model was established based on PBBC and ALB at initial diagnosis,dividing patients into groups a,b,and c:group A(PBBC≤6.5 d,ALB>34.45 g/L,no risk factors),group b(PBBC>6.5 d,ALB>34.45 g/L or PBBC≤6.5 d,ALB≤34.45 g/L,1 risk factor),group c(PBBC>6.5 d,ALB≤34.45 g/L,2 risk factors).Genetic mutations and OS were compared among the three groups of patients;differences in various parameters were evaluated using t-test and chi-squared test or rank sum test,and survival analysis was performed using the Kaplan-Meier method.Results COX regression analysis showed that PBBC and ALB were independent factors affecting prognosis,with statistical significance(P<0.05).Comparison of OS among groups revealed median OS values of not reached,1.86 a,and 0.93 a,respectively(a vs.b group,P<0.001;a vs.c group,P<0.001;b vs.c group,P=0.001),with statistically significant differences indicating that the OS and PFS of the no-risk group were better than those with 1 to 2 risk factors.It was found that CEBPA double mutation and NPM1 gene mutation among the three groups were not statistically significant(P>0.05),but C-KIT gene mutation was statistically significant(P<0.05).Conclusion PBBC and ALB are independent risk factors for the prognosis of AML patients.A simple prognostic model composed of PBBC

关 键 词：急性髓系白血病 外周血原始细胞清除 白蛋白 基因突变 预后 

分 类 号：R557[医药卫生—血液循环系统疾病]