PTX3在继发性噬血细胞性淋巴组织细胞增多症中的表达及临床意义分析

The clinical significance of plasma PTX3 in patients with secondary hemophagocytic lymphohistiocytosis

目的探讨血浆PTX3在继发性噬血细胞性淋巴组织细胞增多症(sHLH)的表达水平及其临床意义。方法回顾性分析2017年1月至2019年7月南京医科大学第一附属医院48例sHLH患者外周血浆标本,以18名健康体检者、9例淋巴瘤患者为对照,ELISA法检测血浆PTX3水平。收集患者相关实验室检查数据,并根据血浆PTX3的表达水平进行诊断及预后分析等。结果初诊sHLH组血浆PTX3表达水平明显高于健康对照组[16.29(1.17~66.00)比0.76(0.01~7.86)μg/L,P<0.01];初诊淋巴瘤相关HLH组(LHLH)血浆PTX3水平明显高于感染相关HLH组(IHLH)[24.29(3.36~66.00)比9.56(1.17~36.50)μg/L,P<0.05]。48例sHLH患者血浆PTX3水平与血清铁蛋白正相关(P<0.05)。血浆PTX3以3.9 μg/L为最佳临界值时,其判断sHLH患者及健康对照组的敏感度及特异度分别为86.7%及94.4%;血浆PTX3以17.5 μg/L为最佳临界值时,其判断LHLH组与non-LHLH组的敏感度及特异度分别为63.0%及76.2%。对初诊sHLH组进行预后分析,多因素分析显示PTX3≥17.5 μg/L组1年总生存率(18.5%)与PTX3<17.5 μg/L组(75.8%)相比,差异有统计学意义(P<0.01)。结论血浆PTX3在sHLH患者的诊断、LHLH鉴别诊断、预后分析等方面具有重要的临床意义。

Objective To investigate the significance of plasma pentraxin 3(PTX3)in patients with secondary hemophagocytic lymphohistiocytosis(sHLH).Methods Plasma PTX3 levels were tested by ELISA in 48 newly diagnosed sHLH patients,18 healthy volunteers and 9 lymphoma controls in the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2019.Clinical parameters were collected,and the correlations with PTX3 levels were analyzed.Results PTX3 level in newly diagnosed group was significantly higher than that of healthy control group[16.29(1.17-66.00)vs.0.76(0.01-7.86)μg/L,P<0.01].Patients with lymphoma-associated HLH(LHLH)had higher plasma level of PTX3 than Fhose with infection-associated HLH(IHLH)[24.29(3.36-66.00)vs.9.56(1.17-36.50)μg/L,P<0.05].Plasma PTX3 levels in 48 sHLH patients were positively correlated with serum ferritin(P<0.05).Receiver operating characteristic(ROC)curve for plasma PTX3 levels of sHLH and healthy controls produced a cutoff value at 3.9μg/L,with its 86.7%sensitivity and 94.4%specificity.And ROC analysis showed that PTX317.5μg/L was the critical value for diagnosis of LHLH from non-LHLH group,that the sensitivity and specificity were 63.0%and 76.2%respectively.The 1-year overall survival(OS)rate in patients with PTX3≥17.5μg/L was significantly lower in those with PTX3<17.5μg/L(18.5%vs.75.8%,P<0.01).Conclusion These results indicate the potential of PTX3 as a biomarker for diagnosis and prognosis in patients with sHLH.