促肾上腺皮质激素在初诊急性髓系白血病患者中的预后价值分析  

Prognostic Value of Adrenocorticotropic Hormone in Patients with Newly Diagnosed Acute Myeloid Leukemia

作　　者：丁林林 赵苗苗 刘文洁 孙倩[1] 洪鸣[1] 钱思轩[1] DING Linlin;ZHAO Miaomiao;LIU Wenjie(Department of Hematology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院血液科,210029

出　　处：《医学研究杂志》2024年第11期46-50,共5页Journal of Medical Research

基　　金：国家自然科学基金资助项目(82170153)。

摘　　要：目的 探讨初诊急性髓系白血病(acute myeloid leukemia, AML)患者促肾上腺皮质激素(adrenocorticotropic hormone, ACTH)水平的临床特征及预后意义。方法 回顾性分析2015年1月~2021年10月连续收治的235例初诊AML患者的临床资料及生存情况,采用Kaplan-Meier法绘制ACTH组间生存曲线。采用COX回归分析筛选影响患者生存的危险因素,R软件构建预后模型后采用校准曲线进行验证。结果 在235例AML患者中,ACTH低于7.2pg/ml者40例。Kaplan-Meier生存曲线分析结果提示,低ACTH组患者生存时间明显缩短。单因素COX回归分析结果显示,年龄、欧洲白血病网(European Leukemia Net, ELN)预后分型、美国东部肿瘤协作组(Eastern Cooperative Oncology Group, ECOG)评分、ACTH水平与患者预后不良相关(P<0.05)。多因素COX回归分析结果显示,年龄、ELN预后分层、ECOG评分、ACTH水平是患者生存的独立影响因素(P<0.05)。利用这4个变量构建了预测总生存期的列线图并建立概率校准图,显示模型的校正曲线与标准曲线接近,表现出良好的线性关系。结论 ACTH水平低下是AML患者生存的独立不良预后因素,基于年龄、ELN预后分层、ECOG评分、ACTH水平这4个变量构建的列线图有较好的预测价值。Objective To explore the clinical characteristics and prognostic significance of adrenocorticotropic hormone(ACTH)level in patients with acute myeloid leukemia(AML).Methods A total of 235 AML patients were enrolled from January 2015 to October 2021.The survival curves between ACTH groups were drawn by Kaplan-Meier.The risk factors of overall survival(OS)were analyzed by COX regression analysis.The prognostic model was constructed by R software and verified by calibration curve.Results Among 235 AML patients,the ACTH level of 40 patients were lower than 7.2pg/ml.Kaplan-Meier survival curve analysis indicated that the survival time of patients with low ACTH was significantly shortened.Univariate analysis showed that age,prognosis classification of European Leukemia Net(ELN),Eastern Cooperative Oncology Group(ECOG)score,and ACTH were correlated with poor survival in AML patients(P<0.05).Multivariate COX regression analysis showed that age,prognosis classification of ELN,ECOG score,and ACTH level were the independent factors for patient survival(P<0.05).A nomogram and calibration curves for predicting overall survival were constructed using these factors,which showed that the calibration curve of the model was close to the standard curve,showing a good linear relationship.Conclusion Low ACTH level is an independent prognostic factor for survival in AML patients,and a model of nomogram constructed based on age,prognostic classification of ELN,ECOG score and ACTH level has a good predictive value.

关 键 词：促肾上腺皮质激素 急性髓系白血病 危险因素 列线图模型 

分 类 号：R733[医药卫生—肿瘤]