中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2014年
12期
1095-1099
,共5页
杨文睿%武志洁%赵馨%井丽萍%张莉%周康%彭广新%李洋%叶蕾
楊文睿%武誌潔%趙馨%井麗萍%張莉%週康%彭廣新%李洋%葉蕾
양문예%무지길%조형%정려평%장리%주강%팽엄신%리양%협뢰
贫血,再生障碍性%血小板生成素%免疫抑制法
貧血,再生障礙性%血小闆生成素%免疫抑製法
빈혈,재생장애성%혈소판생성소%면역억제법
Anemia,aplastic%Thrombopoietin%Immunosuppression
目的 讨论骨髓残存造血评估指标对再生障碍性贫血(AA)患者免疫抑制治疗(IST)疗效预测的价值.方法 回顾性分析38例重型/极重型AA(SAA/VSAA)患者病例资料,将患者治疗前外周血网织红细胞绝对计数(Ret)、中性粒细胞绝对计数(ANC)、血清可溶性转铁蛋白受体(sTfR)及矫正血清血小板生成素(TPO)基线水平对IST后3个月、6个月疗效的影响进行分析并绘制Ret、ANC、sTfR及矫正TPO水平预测IST疗效的ROC曲线.结果 IST后6个月获得血液学反应患者中位Ret、ANC、sTfR基线水平分别为19.9 (2.7～84.4)×109/L、0.59 (0.12～2.67)×109/L及0.82 (0.22～1.58) mg/L,均高于未获得血液学反应者[5.1(1.5～23.1)×109/L、0.20 (0.04～1.33)×109/L及0.45 (0.19～0.72) mg/L];矫正血清TPO水平为142.9(31.8～1 035.0),低于未获得血液学反应者[2 335.0(1 308.3～7 771.2)],差异均有统计学意义(P值均＜0.05).根据ROC曲线获得Ret、ANC、sTfR及矫正TPO预测IST后6个月血液学反应的界限值分别为6.75×109/L、0.30× 109/L、0.76 mg/L及148.6.采用相应界限值对患者进行分组,7例高Ret、ANC、sTfR及低矫正TPO水平患者IST后6个月均获得血液学反应,9例低Ret、ANC、sTfR及高矫正TPO水平患者中仅1例获得血液学反应.结论 评估骨髓残存造血的参数Ret、ANC、sTfR及矫正TPO水平可用于预测AA患者IST近期疗效.
目的 討論骨髓殘存造血評估指標對再生障礙性貧血(AA)患者免疫抑製治療(IST)療效預測的價值.方法 迴顧性分析38例重型/極重型AA(SAA/VSAA)患者病例資料,將患者治療前外週血網織紅細胞絕對計數(Ret)、中性粒細胞絕對計數(ANC)、血清可溶性轉鐵蛋白受體(sTfR)及矯正血清血小闆生成素(TPO)基線水平對IST後3箇月、6箇月療效的影響進行分析併繪製Ret、ANC、sTfR及矯正TPO水平預測IST療效的ROC麯線.結果 IST後6箇月穫得血液學反應患者中位Ret、ANC、sTfR基線水平分彆為19.9 (2.7～84.4)×109/L、0.59 (0.12～2.67)×109/L及0.82 (0.22～1.58) mg/L,均高于未穫得血液學反應者[5.1(1.5～23.1)×109/L、0.20 (0.04～1.33)×109/L及0.45 (0.19～0.72) mg/L];矯正血清TPO水平為142.9(31.8～1 035.0),低于未穫得血液學反應者[2 335.0(1 308.3～7 771.2)],差異均有統計學意義(P值均＜0.05).根據ROC麯線穫得Ret、ANC、sTfR及矯正TPO預測IST後6箇月血液學反應的界限值分彆為6.75×109/L、0.30× 109/L、0.76 mg/L及148.6.採用相應界限值對患者進行分組,7例高Ret、ANC、sTfR及低矯正TPO水平患者IST後6箇月均穫得血液學反應,9例低Ret、ANC、sTfR及高矯正TPO水平患者中僅1例穫得血液學反應.結論 評估骨髓殘存造血的參數Ret、ANC、sTfR及矯正TPO水平可用于預測AA患者IST近期療效.
목적 토론골수잔존조혈평고지표대재생장애성빈혈(AA)환자면역억제치료(IST)료효예측적개치.방법 회고성분석38례중형/겁중형AA(SAA/VSAA)환자병례자료,장환자치료전외주혈망직홍세포절대계수(Ret)、중성립세포절대계수(ANC)、혈청가용성전철단백수체(sTfR)급교정혈청혈소판생성소(TPO)기선수평대IST후3개월、6개월료효적영향진행분석병회제Ret、ANC、sTfR급교정TPO수평예측IST료효적ROC곡선.결과 IST후6개월획득혈액학반응환자중위Ret、ANC、sTfR기선수평분별위19.9 (2.7～84.4)×109/L、0.59 (0.12～2.67)×109/L급0.82 (0.22～1.58) mg/L,균고우미획득혈액학반응자[5.1(1.5～23.1)×109/L、0.20 (0.04～1.33)×109/L급0.45 (0.19～0.72) mg/L];교정혈청TPO수평위142.9(31.8～1 035.0),저우미획득혈액학반응자[2 335.0(1 308.3～7 771.2)],차이균유통계학의의(P치균＜0.05).근거ROC곡선획득Ret、ANC、sTfR급교정TPO예측IST후6개월혈액학반응적계한치분별위6.75×109/L、0.30× 109/L、0.76 mg/L급148.6.채용상응계한치대환자진행분조,7례고Ret、ANC、sTfR급저교정TPO수평환자IST후6개월균획득혈액학반응,9례저Ret、ANC、sTfR급고교정TPO수평환자중부1례획득혈액학반응.결론 평고골수잔존조혈적삼수Ret、ANC、sTfR급교정TPO수평가용우예측AA환자IST근기료효.
Objective To evaluate the prognostic value of residual bone marrow hematopoiesis in severe aplastic anemia (SAA) patients with immunosuppressive therapy (IST).Methods Clinical data and hematologic responses of 38 SAA patients treated with IST regimen (antithymocyte globulin combined with cyclosporine) in our hospital were retrospectively analyzed.Correlation of pre-IST baseline reticulocyte (Ret),absolute neutrophils count (ANC),soluble transferrin receptor (sTfR) concentration,corrected TPO value and hematologic response rate were statistically analyzed and receiver operating characteristic (ROC) curve was used to estimate the value of Ret,ANC,sTfR,and corrected TPO in predicting early IST response.Results Responders to IST had significantly higher pre-IST baseline Ret,ANC,sTfR concentration [19.9 (2.7-84.4) × 109/L,0.59 (0.12-2.67) × 109/L,0.82 (0.22-1.58) mg/L] and lower corrected TPO value [142.9(31.8-1 035.0)] than non-responders [5.1 (1.5-23.1) × 109/L,0.20(0.04-1.33) × 109/L,0.45 (0.19-0.72) mg/L and 2 335.0 (1 308.3-7 771.2)] (P＜0.05).Optimizing parameter cutoff levels obtained from ROC curve was Ret 6.75 × 109/L,ANC 0.30 × 109/L,sTfR 0.76 mg/L and corrected TPO 148.6,respectively.Combining the four parameters to predict 6 month hemotologic response showed that all the 7 patients with high Ret,ANC,sTfR and low corrected TPO,while only 1 among those 9 with low Ret,ANC,sTfR and high corrected TPO.Conclusion Such parameters evaluating residual bone marrow hematopoiesis as Ret,ANC,sTfR,corrected TPO are practical in predicting early IST response in SAA.
