原发性免疫性血小板减少症治疗无反应的危险因素分析  

Influencing factors of no-response to treatment in patients with primary immune thrombocytopenia

作　　者：邵丽佳 沈利洪 冯胜春 赵硕 马拥军 章敬成 SHAO Lijia;SHEN Lihong;FENG Shengchun;ZHAO Shuo;MA Yongjun;ZHANG Jingcheng(Department of Clinical Laboratory,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属金华医院检验科,321000 [2]浙江大学医学院附属金华医院血液科,321000

出　　处：《浙江医学》2024年第23期2510-2514,2520,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2023RC296)。

摘　　要：目的探讨原发性免疫性血小板减少症(ITP)治疗无反应的危险因素。方法回顾性分析2020年1月至2022年12月浙江大学医学院附属金华医院收治的102例ITP患者,根据疗效将患者分为有反应组和无反应组,比较两组患者的临床特点、实验室检查结果。采用多因素logistic回归分析ITP患者治疗无反应的危险因素。绘制ROC曲线分析淋巴细胞(L)、中性粒细胞(N)/L比值(NLR)、PLT/L比值(PLR)、PLT/N比值(PNR)对ITP患者治疗无反应的预测效能。结果102例ITP患者有反应组60例,无反应组42例。与有反应组比较,无反应组患者的年龄更小,L更低,住院天数更多,ITP病程更长,幽门螺杆菌(Hp)和HBV感染率、PLT、NLR、PLR和PNR值更高(均P<0.05)。多因素logistic回归分析结果显示,低龄、较长的住院天数、HBV感染、高PLR均是ITP患者治疗无反应的危险因素。ROC曲线分析发现,L预测ITP患者治疗无反应的AUC为0.640(95%CI:0.531~0.749,P<0.05),在最佳截断值为0.975×10^(9)/L时,灵敏度为0.50,特异度为0.73;NLR预测ITP患者治疗无反应的AUC为0.626(95%CI:0.518~0.734,P<0.05),在最佳截断值为2.53%时,灵敏度为0.95,特异度为0.35;PLR预测ITP患者治疗无反应的AUC为0.806(95%CI:0.719~0.892,P<0.01),在最佳截断值为17.81%时,灵敏度为0.79,特异度为0.75;PNR预测ITP患者治疗无反应的AUC为0.753(95%CI:0.657~0.849,P<0.01),在最佳截断值为4.17%时,灵敏度为0.76,特异度为0.70。结论低龄、较长的住院天数、HBV感染、高PLR是ITP患者治疗无反应的危险因素。Objective To investigate the risk factors of no-response to treatment in patients with primary immune thrombocytopenia(ITP).Methods Clinical data of 102 ITP patients treated in Affiliated Jinhua Hospital of Zhejiang University School of Medicine from January 2020 to December 2022 were retrospectively analyzed,among whom 60 cases responded to treatment(response group)and 42 cases did not respond to treatment(non-response group).The clinical features and laboratory test results were compared between two groups.Binary multivariate logistic regression analysis was used to identify risk factors of non-responsiveness to treatment in ITP patients,and the performance of identified risk factors for predicting treatment response was analyzed with ROC curve.Results Compared with the response group,patients in the non-response group had younger ages;had lower lymphocyte count(L),higher platelet(PLT),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and platelet-to-neutrophil ratio(PNR)values;longer hospital stay,longer ITP disease courses,and higher rates of Helicobacter pylori(Hp)and hepatitis B virus(HBV)infections(all P<0.05).Binary multivariate logistic regression analysis showed that younger age,longer hospital stay,HBV infection,and high PLR were independent risk factors for non-response to treatment in ITP patients.ROC curve analysis showed that the AUC of L for predicting non-response to ITP treatment was 0.640(95%CI:0.531-0.749,P<0.05),with a sensitivity of 0.50 and specificity of 0.73(cut-off value of 0.975×109/L);the AUC of NLR was 0.626(95%CI:0.518-0.734,P<0.05),with a sensitivity of 0.95 and specificity of 0.35(cut-off value of 2.53%);the AUC of PLR was 0.806(95%CI:0.719-0.892,P<0.01),with a sensitivity of 0.79 and specificity of 0.75(cut-off value of 17.81%);the AUC of PNR was 0.753(95%CI:0.657-0.849,P<0.01),with a sensitivity of 0.76 and specificity of 0.70(cut-off value of 4.17%).Conclusion Young age,longer hospital stay,HBV infection,and high PLR are risk factors for treatment non-respons

关 键 词：原发性免疫性血小板减少症 预后 淋巴细胞 中性粒细胞 乙型肝炎病毒 

分 类 号：R558.2[医药卫生—血液循环系统疾病]