基于Th17/Treg、淋巴细胞亚群、骨髓细胞学分析继发性噬血细胞综合征预后的影响因素  

Based on Th17/Treg cells,lymphocyte subsets and bone marrow cytology to investigate the enfluence factors of prognosis of secondary hemophagocytic syndrome

作　　者：彭喆 王雨佳 李欣[1] 邢沛 PENG Zhe;WANG Yujia;LI Xin;XING Pei(Department of Clinical Laboratory,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 101400,China;Medical Records and Clinical Data Center,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]首都医科大学附属北京友谊医院检验科,北京101400 [2]北京大学第一医院病案与临床数据中心,北京100034

出　　处：《检验医学与临床》2024年第24期3719-3725,共7页Laboratory Medicine and Clinic

摘　　要：目的基于辅助性T淋巴细胞(Th)17/调节性T淋巴细胞(Treg)、淋巴细胞亚群、骨髓细胞学探讨继发性噬血细胞综合征(HPS)预后的影响因素,为临床防治提供参考。方法选取2020年3月至2023年4月首都医科大学附属北京友谊医院收治的250例继发性HPS患者为研究对象,参照国际组织细胞协会HLH-2004方案进行治疗,根据治疗3个月情况分为预后良好组、预后不良组,比较两组临床资料、外周血实验室检测指标、Th17/Treg、淋巴细胞亚群及骨髓细胞学指标,分析继发性HPS预后不良的影响因素并构建预测模型,分析模型对继发性HPS预后预测的临床效用及实际符合率。结果250例继发性HPS患者根据治疗3个月后情况分为预后良好组(157例)、预后不良组(93例),预后良好组血小板计数高于预后不良组,乳酸脱氢酶、天冬氨酸转氨酶、凝血酶原时间低于预后不良组(P<0.05);预后良好组Th17、Th17/Treg、CD19^(+)、粒细胞毒性改变比例低于预后不良组,Treg、CD4^(+)/CD8^(+)、CD16^(+)CD56^(+)高于预后不良组(P<0.05);经Lasso回归筛选出血小板计数、乳酸脱氢酶、Th17、Treg、Th17/Treg、CD4^(+)/CD8^(+)、CD19^(+)、CD16^(+)CD56^(+)、粒细胞毒性改变9个特征变量,多因素Logistic回归分析显示上述变量均为继发性HPS预后不良的影响因素(P<0.05);构建预测模型获得继发性HPS患者预后不良的风险概率;Logistic回归模型预测继发性HPS预后有良好临床效用和较高实际符合率。结论继发性HPS的预后受血小板计数、乳酸脱氢酶、Th17、Treg、Th17/Treg、CD4^(+)/CD8^(+)、CD19^(+)、CD16^(+)CD56^(+)、粒细胞毒性改变等因素影响,基于Th17/Treg、淋巴细胞亚群、骨髓细胞学预测继发性HPS预后有较高价值与实际符合率,临床效用良好。Objective To explore the enfluence factors of prognosis of secondary hemophagocytic syndrome(HPS)based on helper T cells(Th)17/regulatory T cells(Treg),lymphocyte subsets and bone marrow cytology,and to provide a favorable reference for clinical prevention and treatment.Methods Two hundred and fifty patients with secondary HPS admitted to Peking University First Hospital from March 2020 to April 2023 were selected as objects and treated with reference to the HLH-2004 protocol of the International Tissue Cell Association,patients were divided into good prognosis group and poor prognosis group according to the prognostic status of the treatment for 3 months.The clinical data,peripheral blood laboratory detection indicators,Th17/Treg,lymphocyte subsets and bone marrow cytological indicators of the two groups were compared to analyze the factors affecting the poor prognosis of secondary HPS and construct a prediction model,and analyze the clinical effectiveness and actual agreement rate of the model in predicting the prognosis of secondary HPS.Results The 250 patients with secondary HPS were classified into good prognosis group(157 cases)and poor prognosis group(93 cases)according on the effectiveness of treatment for 3 months.The platelet count of the good prognosis group was higher than that of the poor prognosis group,the lactate dehydrogenase,aspartate aminotransferase and prothrombin time were lower than those of the poor prognosis group(P<0.05).The Th17,Th17/Treg,CD19^(+)and granulocyte toxicity in the good prognosis group were lower than those in the poor prognosis group,the Treg,CD4^(+)/CD8^(+)and CD16^(+)CD56^(+)in the good prognosis group were higher than those in poor prognosis group(P<0.05).Nine characteristic variables including platelet count,lactate dehydrogenase,Th17,Treg,Th17/Treg,CD4^(+)/CD8^(+),CD19^(+),CD16^(+)CD56^(+)and granulocyte toxicity were screened by Lasso regression.Multivariate Logistic regression analysis showed that the above variables were influence factors for poor prognosis of seco

关 键 词：继发性噬血细胞综合征 辅助性T细胞 调节性T细胞 淋巴细胞亚群 骨髓细胞学 影响因素 

分 类 号：R446.6[医药卫生—诊断学]