BCR::ABL融合基因阴性骨髓增殖性肿瘤患者右心功能异常影响因素分析  

Influencing factors analysis of right heart dysfunction in myeloproliferative neoplasm patients with BCR::ABL fusion gene-negative

作　　者：柴星星[1] 卢璇 庄万传[1] 何耀[1] 何广胜[3] 李建勇[3] Chai Xingxing;Lu Xuan;Zhuang Wanchuan;He Yao;He Guangsheng;Li Jianyong(Department of Hematology,the Second People's Hospital of Lianyungang,Lianyungang 222000,China;School of Life Sciences,Hefei Normal University,Hefei 230000,China;Department of Hematology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]连云港市第二人民医院血液科,连云港222000 [2]合肥师范学院生命科学学院,合肥230000 [3]南京医科大学第一附属医院江苏省人民医院血液科,南京210029

出　　处：《白血病．淋巴瘤》2024年第10期603-609,共7页Journal of Leukemia & Lymphoma

基　　金：国家中医药管理局行业专项(201407001-4);江苏省医学重点项目(BL2014086);江苏省普通高校优势学科(JX10231801);连云港市卫生健康委员会项目(202119)。

摘　　要：目的探讨BCR::ABL融合基因阴性骨髓增殖性肿瘤(MPN)患者发生右心功能异常的影响因素。方法回顾性病例对照研究。选取2020年1月至2022年12月连云港市第二人民医院收治的130例BCR::ABL融合基因阴性MPN患者,收集患者一般资料、实验室指标及心功能参数,根据超声心动图判断的是否存在右心功能异常将患者分为观察组(34例)和对照组(96例)。比较两组患者一般资料、实验室指标及超声心动图检查心功能参数。采用多因素logistic回归分析BCR::ABL融合基因阴性MPN患者发生右心功能异常的独立影响因素。以超声心动图判断的右心功能异常为金标准,绘制依据筛选的独立影响因素预测右心功能异常发生的受试者工作特征(ROC)曲线,分析这些因素的预测效能。结果130例患者中位年龄57岁(范围:19~76岁),男性62例,女性68例;原发性血小板增多症69例,真性红细胞增多症35例,原发性骨髓纤维化26例。观察组中年龄>60岁、伴高血压、有栓塞史、伴肺动脉高压患者比例均高于对照组,差异均有统计学意义(均P<0.05);两组间性别、体质量指数>28 kg/m^(2)、吸烟、饮酒、伴糖尿病、伴高血脂、各病理类型的患者构成差异均无统计学意义(均P>0.05)。观察组白细胞计数、中性粒细胞计数、嗜碱粒细胞数、单核细胞计数、红细胞计数、红细胞比容(Hct)、CD34^(+)细胞密度、血小板计数均高于对照组,差异均有统计学意义(均P<0.05);两组间淋巴细胞计数、嗜酸粒细胞数、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白水平差异均无统计学意义(均P>0.05)。观察组患者心脏射血时间较对照组短,右心房横径、右心室前后径、右心室前壁厚度、等容收缩时间、等容舒张时间、右心室Tei指数均高于对照组,差异均有统计学意义(均P<0.001)。多因素logistic回归分析显示,年龄>60岁(OR=Objective To investigate the factors influencing the right heart dysfunction in myloproliferative neoplasm(MPN)patients with BCR::ABL fusion gene-negative.Methods A retrospective case-control study was conducted.A total of 130 MPN patients with BCR::ABL fusion gene-negative admitted to the Second People's Hospital of Lianyungang from January 2020 to December 2022 were selected as the study objects.The general data,laboratory indexes and cardiac function parameters were collected.All patients were divided into the control group(non-right heart function injury,96 cases)and the observation group(right heart function injury,34 cases)according to whether there was right heart dysfunction judged by ultrasonic cardiogram.Multivariate logistic regression analysis was used to analyze the independent influencing factors of right heart dysfunction in MPN patients with BCR::ABL fusion gene-negative.Taking right heart dysfunction judged by ultrasonic cardiogram as the gold standard,the receiver operating characteristic(ROC)curve was drawn to predict right heart dysfunction according to independent influencing factors,and the diagnostic efficacy of the factors was analyzed.Results The median age was 57 years old(range 19-76 years);among the 130 patients,62 cases were male and 68 cases were female.There were 69 cases of primary thrombocytosis,35 cases of polycythemia vera and 26 cases of primary myelofibrosis.The proportions of patients with age>60 years old,hypertension,embolism history,pulmonary hypertension in the observation group were higher than those in the control group,and the differences were statistically significant(all P<0.05).There were no statistically significant differences in the composition of patients with gender,body mass index>28 kg/m^(2),smoking,drinking,diabetes,hyperlipidemia and different pathological types between the two groups(all P>0.05).The white blood cell count,neutrophil count,basophil count,monocyte count,red blood cell count,hematocrit(Hct),CD34^(+)cell count and platelet count in the observa

关 键 词：骨髓增殖性疾病 融合蛋白质类 BCR-ABL 心室功能 右 诊断 

分 类 号：R733.3[医药卫生—肿瘤]