异基因造血干细胞移植治疗重型再生障碍性贫血患者术后植入功能不良预测模型的建立  

Establishment of a predictive model for poor graft function in patients with severe aplastic anemia treated by allogeneic hematopoietic stem cell transplantation

作　　者：马馨 巩娇娇 王娴静[1] Ma Xin;Gong Jiaojiao;Wang Xianjing(The Second Ward of Hematology,the Third People's Hospital of Zhengzhou,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州市第三人民医院血液二病区,河南郑州450000

出　　处：《感染、炎症、修复》2025年第1期38-43,48,共7页Infection Inflammation Repair

摘　　要：目的:建立重型再生障碍性贫血(SAA)患者接受异基因造血干细胞移植(allo-HSCT)治疗后术后植入功能不良(PGF)的预测模型,旨在深入探讨影响PGF发生的危险因素。方法:初步筛选2020年1月至2024年5月期间,在郑州市第三人民医院血液科接受allo-HSCT治疗的SAA患者的临床资料。根据纳入、排除标准,最终纳入258例符合条件的SAA患者作为研究对象。根据移植后植入功能评估结果,将258例SAA患者分为植入功能不良组(PGF组,n=28)和植入功能良好组(GGF组,n=230)。比较PGF组、GGF组间一般资料及临床特征,将有差异的变量纳入Logistic回归模型,分析SAA患者allo-HSCT治疗后发生PGF的危险因素。采用R软件中rms程序构建列线图预测模型,绘制受试者工作特征(ROC)曲线,通过ROC曲线下面积(AUC)及Hosmer-Lemeshow检验评价模型的实用性。结果:二元回归Logistic分析结果显示,移植方式为单倍体相合、造血干细胞提供者为非亲属、移植前铁蛋白上升、输注CD34+细胞数目下降及有巨细胞病毒(CMV)感染是SAA患者allo-HSCT治疗后发生PGF的危险因素(P<0.05)。依据列线图模型,移植方式为单倍体相合、造血干细胞提供者为非亲属、移植前铁蛋白上升、输注CD34+细胞数目下降及有CMV感染,列线图模型对应的评分也随之上升,PGF发生率增加,C-index为0.793(95%CI:0.757-0.884)。绘制ROC曲线对SAA患者allo-HSCT治疗后PGF发生的列线图的预测价值进行评估,结果显示,AUC为0.883(95%CI:0.785-0.902),特异度为83.00%,敏感度为92.20%(Z=10.536,P<0.05)。Hosmer-Lemeshow拟合优度检验=9.020、P=0.401,提示该列线图模型预测SAA患者allo-HSCT治疗后PGF发生的区分度与一致性良好。结论:基于移植方式为单倍体相合、造血干细胞提供者为非亲属、移植前铁蛋白上升、输注CD34+细胞数目下降及有CMV感染构建的列线图,对SAA患者allo-HSCT治疗后PGF发生具有较高预测价值,可为SAA患者的�Objective:To establish a predictive model of poor graft function(PGF)after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with severe aplastic anemia(SAA),in order to further explore the risk factors affecting the occurrence of PGF.Methods:The clinical data of SAA patients who received allo-HSCT in the Department of Hematology of the Third People's Hospital of Zhengzhou from January 2020 to May 2024 were preliminary screened.According inclusion and exclusion criteria,258 eligible SAA patients were finally included as the study subjects.According to the evaluation results of implantation function after transplantation,258 SAA patients were divided into poor graft function group(PGF group,n=28)and good graft function group(GGF group,n=230).The general data and clinical characteristics between the PGF group and the GGF group were compared,and the variables with differences were included in the Logistic regression model to analyze the risk factors of PGF after allo-HSCT in SAA patients.The rms program in R software was used to construct the nomogram prediction model,and the receiver operating characteristic(ROC)curve was drawn.The practicability of the model was evaluated by area under the ROC curve(AUC)and Hosmer-Lemeshow test.Results:Binary Logistic regression analysis showed that haploidentical transplantation,non-relative hematopoietic stem cell donors,increased ferritin before transplantation,decreased number of CD34 cells infused and cytomegalovirus(CMV)infection were risk factors for PGF after allo-HSCT in SAA patients(P<0.05).According to the nomogram model,the transplantation method was haploidentical,the hematopoietic stem cell provider was non-relative,the ferritin increased before transplantation,the number of infused CD34*cells decreased and CMV infection occurred.The corresponding score of the nomogram model also increased,and the incidence of PGF increased.C-index was 0.793(95%CI:0.757-0.884).ROC curve Was drawn to evaluate the predictive value of the nomogram of PGF after all

关 键 词：异基因造血干细胞移植 再生障碍性贫血 术后植入功能不良 预测模型 

分 类 号：R556.5[医药卫生—血液循环系统疾病]