初诊D-二聚体/纤维蛋白原比值在儿童急性淋巴细胞白血病中的预后价值  

Prognostic Value of D-Dimer/Fibrinogen Ratio at Initial Diagnosis in Children with Acute Lymphoblastic Leukemia

作　　者：宋丽丽[1] 马平[1] 管玉洁[1] 黄闪 刘炜[1] SONG Lili;MA Ping;GUAN Yujie;HUANG Shan;LIU Wei(Department of Haematology,Children’s Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院血液肿瘤科,河南郑州450000

出　　处：《河南医学研究》2025年第3期411-416,共6页Henan Medical Research

基　　金：河南省科技发展计划(222102310616)。

摘　　要：目的 探讨急性淋巴细胞白血病(ALL)患儿初诊D-二聚体/纤维蛋白原比值(DFR)在预后中的意义。方法 收集2013年10月至2017年10月在郑州大学附属儿童医院接受化疗的306例ALL患儿的资料,按照随访结果将患儿分为预后良好组和预后不良组,并统计无事件生存期(EFS)。统计患儿一般资料及初诊时的白细胞计数(WBC)、血小板计数(PLT)、乳酸脱氢酶(LDH)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)和D-二聚体(D-D),计算DFR。分析DFR与其他临床指标的相关性,采用受试者工作特征(ROC)曲线评估其预后价值,用约登指数确定最佳截断值。根据DFR最佳截断值将患儿分组,采用Kaplan-Meier法分析其与无事件生存期(EFS)的相关性,组间比较采用log-rank检验。采用单因素及多因素Cox回归分析DFR是否为ALL患儿预后影响因素。结果 DFR与WBC、LDH及TT具有正相关性(P<0.05);预后良好组与预后不良组相比,WBC、Fib、D-D及DFR差异有统计学意义(P<0.05);ROC曲线分析结果显示,DFR诊断预后的曲线下面积为0.689,最佳截断值为0.40,敏感度为86.54%,特异度为56.30%;根据最佳截断值分组,DFR≤0.40组患儿和DFR>0.40组患儿的EFS比较,差异有统计学意义(P<0.001)。多因素分析提示DFR>0.40是患儿预后不良的独立危险因素(P<0.001)。结论 初诊DFR对于ALL患儿的预后具有一定的预测价值,比值升高的患儿生存率明显降低,且预后评估价值优于单用Fib或D-D。Objective To investigate the prognostic significance of D-dimer/fibrinogen ratio at first visit(DFR)in children with acute lymphoblastic leukemia(ALL).Methods The data of 306 children with ALL who received chemotherapy in Children’s Hospital of Zhengzhou University from October 2013 to October 2017 were collected.According to the follow-up results,the children were divided into the good prognosis group and poor prognosis group,and the event-free survival(EFS)was analyzed.The general data,white blood cell count(WBC),platelet count(PLT),lactate dehydrogenase(LDH),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fib)and D-dimer(D-D)at first visit were observed and DFR was calculated.The correlation between DFR and other clinical indicators was analyzed,the receiver operating characteristic(ROC)curve was used to evaluate the prognostic value of DFR,and Jorden index was used to determine the best cut-off value.The ALL children were grouped according to the cut-off value of DFR,Kaplan-Meier method was used to analyze its correlation of EFS,and log-rank test was used for comparison between groups.Uunivariate and multivariate Cox regression was used to analyze whether DFR was a prognostic factor for children with ALL.Results DFR was positively correlated with WBC,LDH and TT(P<0.05).There were significant differences in WBC,Fib,DD and DFR between the good prognosis group and the poor prognosis group(P<0.05).The results of ROC curve analysis showed that the area under the curve of DFR diagnosis and prognosis was 0.689,the cut-off value was 0.40,the sensitivity was 86.54%,and the specificity was 56.30%.According to the cut-off value,the differenc of EFS in the DFR≤0.40 group and DFR>0.40 group was statistically significant(P<0.001).Multivariate analysis suggested that DFR>0.40 was an independent risk factor for poor prognosis(P<0.001).Conclusion DFR at first visit has a certain prognostic significance in children with ALL,and its prognostic value is better than Fib or D-D alo

关 键 词：急性淋巴细胞白血病 儿童 D-二聚体/纤维蛋白原比值 凝血指标 预后 

分 类 号：R733.71[医药卫生—肿瘤]