原发性血小板增多症患者初诊初治时外周血粒淋比与血栓事件关系研究

Relationship between Thrombotic Events and Peripheral Neutrophil-to-lymphocyte Ratio in Patients with Newly Diagnosed Essential Thrombocythemia

目的:探讨初诊初治时中性粒细胞/淋巴细胞比值(NLR)对原发性血小板增多症(ET)患者血栓事件发生和进展的影响及临床意义。方法:回顾性分析150例原发性血小板增多症患者临床和随访资料,用统计学方法分析血栓事件的危险因素。结果:年龄(P=0.001)和JAK2V617F突变(P=0.003)是诊断时血栓事件独立危险因素;年龄(P=0.037)、NLR(P<0.001)、WBC计数(P=0.047)及初诊时血栓病史(P=0.036)是随访过程中未来血栓事件进展的独立危险因素;ROC WBC计数以及初诊时血栓病史。Kaplan-Meier生存分析表明,高NLR组血栓事件无进展生存时间(中位生存时间22.3个月, 95%CI:17.8-26.8)明显低于低NLR组(中位生存时间55.5个月, 95%CI:53.4-57.5)。低NLR组60个月血栓事件无进展生存率为97.4%,而高NLR组60个月血栓事件无进展生存率为46.7%。结论:ET患者初诊初治时外周血NLR水平较传统临床指标对未来血栓事件进展具有更好的诊断预测价值,但与诊断时已经发生的血栓事件没有明显相关性。

Objective:To explore the role of neutrophil-to-lymphocyte ratio(NLR)in patients with newly diagnosed essential thrombocythemia(ET)and its relationship with thrombotic events.Methods:The clinical and follow-up data of 150 ET patients were retrospectively analyzed.The risk factors of thrombotic events and role of NLR by statistical methods.Results:Age(P<0.01)and JAK2V617F mutation(P<0.01)were the independent risk factors for thrombotic events at diagnosis;WBC count(P<0.05),NLR(P<0.01),age(P<0.05)and thrombosis history at diagnosis(P<0.05)were independent risk factors for future thrombotic events.The ROC curve showed that NLR for prediction of future thrombotic events was suprior to other risk factors.The Kaplan-Meier analysis showed that the progress-free survival time in thrombotic events patients with higher NLR(median survival 22.3 months,95% CI:17.8-26.8)was significantly shorter than that of patients with lower NLR(median survival 55.5 months,95% CI:53.4-57.5).After follow-up 60 months,the thrombosis progress-free survival in lower NLR patients reached 97.4%,while that in the patients with higher NLR was rate 46.7%.Conclusion:NLR at diagnosis is a better predictive parameter for future thrombotic events than other clinical parameters in ET patients,but without corralations with thrombosis at diagnosis.