外周血单核细胞绝对计数对慢性淋巴细胞白血病预后判断的价值

doi:10.3969/j.issn.1006-7795.2018.04.019

首都医科大学学报 ›› 2018, Vol. 39 ›› Issue (4): 581-585.doi: 10.3969/j.issn.1006-7795.2018.04.019

外周血单核细胞绝对计数对慢性淋巴细胞白血病预后判断的价值

马小雯, 董春霞, 陈剑芳, 王梅芳, 张睿娟, 张建华, 杨林花

山西医科大学第二医院血液科, 太原 030001

收稿日期:2018-04-19 出版日期:2018-07-21 发布日期:2018-07-21
通讯作者: 杨林花 E-mail:yanglh5282@163.com
基金资助:
山西省科技创新团队（201605D131044-05），山西省应用基础研究项目（201601D202094），山西医科大学大学生创新创业校级项目（20172116）。

Prognostic value of absolute monocyte count in chronic lymphocytic leukemia

Ma Xiaowen, Dong Chunxia, Chen Jianfang, Wang Meifang, Zhang Ruijuan, Zhang Jianhua, Yang Linhua

Department of Hematology, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, China

Received:2018-04-19 Online:2018-07-21 Published:2018-07-21
Supported by:
This study was supported by Science and Technology Innovation Team of Shanxi Province (201605D131044-05), Applied to Basic Research of Shanxi Province (201601D202094), University Innovation and Entrepreneurship School-level Project of Shanxi Medical College (20172116).

摘要/Abstract

摘要： 目的通过分析慢性淋巴细胞白血病（chronic lymphocytic leukemia，CLL）患者的临床、实验室及随访资料探讨外周血单核细胞绝对计数（absolute monocyte count，AMC）对CLL的预后价值。方法对2002年1月至2017年12月收住山西医科大学第二医院的54例慢性淋巴细胞白血病患者的临床特点、实验室检查、治疗效果、预后进行分析，探讨影响CLL的预后因素。结果 54例患者中，男女比例为2：1，中位年龄为64岁；其中Binet A期8例，B期25例，C期21例；以疾病进展作为终点得到外周血AMC的受试者工作特征（receiver operating characteristics，ROC）曲线，AMC的截点值为0.67×10⁹/L，曲线的最佳灵敏度为0.710，特异度为0.783，曲线下面积（area under the curve，AUC）为0.771（95% CI：0.644~0.899）。以0.67×10⁹/L为界限，分为高AMC组和低AMC组，低AMC组的患者无进展生存期优于高AMC组（P<0.05），但高AMC组与低AMC组之间总生存期差异无统计学意义（P=0.170）。Cox回归结果表明疾病分期为C期（P=0.038）是总生存期的独立影响因素，AMC>0.67×10⁹/L（P=0.004）及疾病分期为C期（P=0.049）是无进展生存期的独立影响因素。结论初诊时较高的AMC与CLL较快的疾病进展有关，可能为CLL的预后判断提供新依据。

关键词: 慢性淋巴细胞白血病, 临床特征, 外周血单核细胞绝对计数, 预后

Abstract: Objective To explore the possible prognostic function of absolute monocyte count (AMC) for chronic lymphocytic leukemia (CLL) through the analysis of 54 CLL patients' clinical symptoms, laboratory features and follow-up data. Methods Retrospectively analyze 54 patients admitted to Department of Hematology, the Second Hospital of Shanxi Medical University from January 2002 to December 2017 with their clinical features, laboratory examinations, treatment process and outcome. Kaplan-Meier method was used to calculate the survival rate and draw the survival curve and the risk curve. Log-rank test was used to compare the survival rates between different groups. Cox proportional hazards model was used for multivariate analysis of prognostic factors in CLL. Results The male to female ratio was 2:1 among 54 cases of patients, the median age was 64-years-old. There were 8 cases belong to Binet A, 25 cases belong to Binet B and 21 cases belong to Binet C. We used disease progression to get the receiver operating characteristics (ROC) curve of AMC, the cutoff point of AMC was 0.67×10⁹/L, the optimal curve of sensitivity was 0.710, specificity was 0.783, the area under the curve (AUC) was 0.771 (95% CI:0.644-0.899). We divided the patients into high and low AMC group according to the cutoff point. There was no significant differences between high AMC group and low AMC group in overall survival (OS)(P=0.170), but progression free survival (PFS) results suggested high AMC group may progress quicker than low AMC group (P<0.05). Cox regression analysis suggested that disease stage belong to Binet C (P=0.038) was an independent factor affecting OS, while the AMC at the diagnosis>0.67×10⁹/L (P=0.004) and the Binet C stage (P=0.049) were independent risk factors of PFS. Conclusion High AMC level at diagnosis suggested rapid disease progression and may become a new evidence for the prognosis of CLL.

Key words: chronic lymphocytic leukemia, clinical features, absolute monocyte count, prognosis

中图分类号:

R733.7

马小雯, 董春霞, 陈剑芳, 王梅芳, 张睿娟, 张建华, 杨林花. 外周血单核细胞绝对计数对慢性淋巴细胞白血病预后判断的价值[J]. 首都医科大学学报, 2018, 39(4): 581-585.

Ma Xiaowen, Dong Chunxia, Chen Jianfang, Wang Meifang, Zhang Ruijuan, Zhang Jianhua, Yang Linhua. Prognostic value of absolute monocyte count in chronic lymphocytic leukemia[J]. Journal of Capital Medical University, 2018, 39(4): 581-585.

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外周血单核细胞绝对计数对慢性淋巴细胞白血病预后判断的价值

Prognostic value of absolute monocyte count in chronic lymphocytic leukemia

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