基因突变结合临床合并症指数对骨髓增生异常综合征预后的影响研究  

Effect of gene mutation combined with clinical complication index on prognosis of myelodysplastic syndrome

作　　者：周铭 胡蒙蒙 沈英英 郑智茵[1] 武利强[1] 俞庆宏[1] 王博 叶宝东[1] 沈建平[1] 林圣云[1] ZHOU Ming;HU Meng-meng;SHEN Ying-ying;ZHENG Zhi-yin;WU Li-qiang;YU Qing-hong;WANG Bo;YE Bao-dong;SHEN Jian-ping;LIN Sheng-yun(Department of Hematology,the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310006,China;不详)

机构地区：[1]浙江中医药大学附属第一医院血液科,浙江杭州310006 [2]绍兴文理学院附属医院(绍兴市立医院)血液科,浙江绍兴312000

出　　处：《中国实用内科杂志》2025年第1期67-72,共6页Chinese Journal of Practical Internal Medicine

基　　金：浙江省科技厅重点研发项目(2019C03047)。

摘　　要：目的探究基因突变与年龄校正的查尔森合并症指数(aCCI)对骨髓增生异常综合征(MDS)患者预后的影响。方法选取2019年3月至2023年10月期间于浙江中医药大学附属第一医院及合作医院就诊的155例骨髓增生异常综合征(MDS)患者的数据资料,运用Cox比例回归风险模型筛查影响MDS患者预后的危险因素。结果IPSS-R危险度分层(HR 1.337,95%CI 1.055~1.694)、a CCI(HR 1.317,95%CI 1.164~1.490)和突变基因TP53(HR 3.532,95%CI2.034~6.135)、NRAS(HR 3.278,95%CI 1.528~7.031)、ZRSR2(HR 4.163,95%CI 1.625~10.665)对MDS患者的总生存期(OS)存在负面影响(P<0.05);aCCI(HR 1.393,95%CI 1.114~1.743)和突变基因RUNX1(HR 2.259,95%CI 1.043~4.890)、KRAS(HR 4.398,95%CI 1.471~13.148)对MDS患者的无白血病生存期(LFS)存在负面影响(P<0.05)。结论基因突变与a CCI影响MDS患者的预后,且两种危险因素间可能存在联系。Objective To investigate the impact of gene mutation and age-adjusted Chilson Comorbidity Index(aCCI)on the prognosis of patients with myelodysplastic syndrome(MDS).Methods Data of 155 patients with myelodysplastic syndrome(MDS)who underwent treatment in the First Affiliated Hospital of Zhejiang Chinese Medical University and other partner hospitals from March 2019 to October 2023 were selected.Cox proportional regression risk models were utilized to screen the risk factors influencing the prognosis of MDS patients.Results The IPSS-R risk stratification(HR 1.337,95%CI 1.055-1.694),aCCI(HR 1.317,95%CI 1.164-1.490),mutation genes TP53(HR 3.532,95%CI 2.034-6.135),NRAS(HR 3.278,95%CI 1.528-7.031)and ZRSR2(HR 4.163,95%CI 1.625-10.665)all exerted negative impacts on the overall survival(OS)of MDS patients(P<0.05).Meanwhile,aCCI(HR 1.393,95%CI 1.114-1.743),the mutated gene RUNX1(HR 2.259,95%CI 1.043-4.890)and KRAS(HR 4.398,95%CI 1.471-13.148)adversely affected the leukemia-free survival(LFS)in MDS patients(P<0.05).Conclusion Gene mutation and aCCI influence the prognosis of MDS patients,and there might be a recessive connection between these two risk factors.

关 键 词：骨髓增生异常综合征 基因突变 查尔森合并症指数 年龄 预后 

分 类 号：R551.3[医药卫生—血液循环系统疾病]