淋巴细胞绝对值对于新诊断的成人原发免疫性血小板减少症患者预后价值研究

The prognostic value of absolute lymphocyte count in patients with newly diagnosed adult primary immune thrombocytopenia

目的:探讨淋巴细胞绝对值(ALC)对于成人新诊断的原发免疫性血小板减少症(ITP)患者预后的影响,为临床评估预后提供新的理论支持。方法:回顾性分析152例成人新诊断的ITP患者的临床及实验室检查结果等指标,总结其临床特点,探讨ALC对于疾病预后的影响,并分析影响患者预后的相关危险因素。结果:152例新诊断ITP患者的中位发病年龄50.5(27.0~63.0)岁;其中男62例,女90例,男∶女为0.69∶1.00。中位随访时间9.75(3.88~25.00)个月,复发24例(15.78%)。以疾病复发作为终点得到外周血ALC的受试者工作特征曲线,ALC的截点值为1.070×10~9/L,曲线下面积为0.604(95%CI 0.491~0.717)。以1.070×10~9/L为界,分为高ALC组和低ALC组,2组临床特征比较显示,高ALC组合并高血压患者比例明显高于低ALC组(P=0.006),其余方面比较差异无统计学意义(P>0.05)。对于影响疾病复发的临床特征进行单因素分析及多因素Logistic回归分析发现,ALC>1.070×10~9/L是影响新诊断的成人ITP复发的独立危险因素(P=0.004)。结论:对于新诊断的成人ITP患者,较高的淋巴细胞计数对于疾病复发有一定的预测作用,应引起重视。

Objective:To explore the influence of absolute lymphocyte count(ALC)on the prognosis of newly diagnosed primary immune thrombocytopenia(ITP)in adults,in order to provide more evidence for the treatment of it.Method:The clinical and laboratory examination results of 152 newly diagnosed adult ITP patients were retrospectively analyzed.The influence of ALC on the prognosis of the disease was discussed,and clinical features and prognostic factors of adult ITP were analyzed.Result:Among 152 newly diagnosed ITP patients,62 were male and 90 were female,and the ratio of male to female was 0.69∶1.00,with an median age was 50.5(27.0-63.0)years old.With a median follow-up of 9.75(3.88-25.00)months,there were 24 patients(15.78%)who finally relapsed.The receiver operating characteristics curve of peripheral blood ALC was obtained with the disease recurrence as the endpoint.The cut-off point value of ALC was 1.070×10~9/L,the area under the curve was 0.604(95%CI 0.491-0.717).Taking 1.070×10~9/L as the boundary,the group was divided into high ALC group and low ALC group.The comparison of clinical features between the two groups showed that patients with hypertension in the high ALC group was significantly higher than that in the low ALC group(P=0.006),and there were no statistically significant differences in other clinical features between two groups.Single factor analysis and multi factor Logistic regression analysis on the clinical characteristics of disease recurrence showed that ALC>1.070×10~9/L was the independent risk factor of ITP recurrence in newly diagnosed adults(P=0.004).Conclusion:For newly diagnosed adult ITP patients,a higher lymphocyte count has a certain predictive effect on disease recurrence,which needs to be taken into account.