急性早幼粒细胞白血病分化综合征的影响因素分析及列线图模型构建  

Analysis of Influencing Factors and Establishment of Nomogram Model of Differentiation Syndrome in Patients with Acute Promyelocytic Leukemia

作　　者：姚一帆 郝李霞 杨林花[1] YAO Yi-Fan;HAO Li-Xia;YANG Lin-Hua(Department of Hematology,The Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院血液内科,山西太原030001

出　　处：《中国实验血液学杂志》2025年第1期62-68,共7页Journal of Experimental Hematology

基　　金：山西省重点研发计划项目(201803D31123)。

摘　　要：目的:探讨急性早幼粒细胞白血病(APL)诱导化疗期间发生分化综合征(DS)的影响因素,建立初诊APL发生DS的列线图预测模型,为临床提供指导。方法:回顾性分析324例初诊APL患者的临床资料,根据有无DS分组,选取组间比较后有统计学意义的指标,纳入单因素及多因素Logistic回归,探讨APL发生DS的影响因素;应用R软件建立列线图预测模型,运用Bootstrap法内部验证,一致性指数及校准曲线评价模型的准确度。结果:324例初诊APL患者的DS发生率为30.86%(100/324)。单因素Logistic回归分析结果表明,患者危险度分层高危、维甲酸用药延迟、未使用激素预防、合并弥散性血管内凝血、初诊时白细胞计数增高、中性粒细胞绝对值增高、凝血酶原时间延长、纤维蛋白原减低、白蛋白减低、骨髓原始细胞比例增高、外周血原始细胞比例增高、化疗后白细胞峰值增高为初诊APL患者发生DS的危险因素(均P<0.01)。多因素Logistic回归分析结果表明,化疗后白细胞计数WBC增高峰值、是否使用激素预防、白蛋白水平是初诊APL患者发生DS的独立影响因素(均P<0.01)。列线图模型预测APL发生DS的一致性指数为0.847(95%CI:0.786-0.908),校准曲线结果显示,列线图预测与实际DS发生率有良好的一致性。结论:初诊APL患者发生DS的独立影响因素为化疗后白细胞计数增高峰值、白蛋白水平及是否使用激素预防,基于上述因素构建的列线图模型可以预测APL发生DS的风险,与临床有良好的一致性。Objective:To investigate the influencing factors of differentiation syndrome(DS)during induction chemotherapy for acute promyelocytic leukemia(APL),and establish a prediction model for DS in newly diagnosed APL patients,in order to guide clinical treatment.Methods:The clinical data of 324 newly diagnosed APL patients were retrospectively analyzed,and the patients were divided into DS group and non-DS group according to whether or not DS was present.Statistically significant factors from comparison of the two groups were selected and included in univariate and multivariate logistic regression to explore the influencing factors of DS in APL.R software was used to build the nomogram model,Bootstrap method was used for internal verification,and concordance index(C-index)and calibration curve were used to evaluate the accuracy of the model.Results:The incidence of DS in 324 patients with newly diagnosed APL was 30.86%(100/324).Univariate logistic regression analysis showed that high risk,delayed retinoic acid,no hormonal prophylaxis,combined with disseminated intravascular coagulation,increased white blood cell count(WBC)at initial diagnosis and neutrophil count,prothrombin prolongation,decreased fibrinogen and albumin(ALB),increased proportion of bone marrow original cells,increased proportion of peripheral blood original cells,and increased peak of WBC after chemotherapy were risk factors for DS in newly diagnosed APL patients(all P<0.01).Multivariate logistic regression analysis showed that the increased peak value of WBC after chemotherapy,prophylactic use of hormone,and ALB level were independent factors influencing the occurrence of DS in newly diagnosed APL patients(all P<0.01).The C-index of DS in APL predicted by the nomogram model was 0.847(95%CI:0.786-0.908).The calibration curve showed that the nomogram was in good agreement with the actual incidence of DS.Conclusion:The independent influencing factors of DS in newly diagnosed APL are the increased peak value of WBC after chemotherapy,ALB and prophylactic

关 键 词：急性早幼粒细胞白血病 分化综合征 早期死亡 预测模型 列线图 

分 类 号：R733.71[医药卫生—肿瘤]