FMS样酪氨酸激酶3配体在急性髓系白血病患者血清中的表达及其临床意义

Expression and clinical significance of Flt3 ligand in serum of patients with acute myeloid leukemia

目的:分析血清FMS样酪氨酸激酶3配体(Flt3 ligand,Flt3L)在急性髓系白血病(acute myeloid leukemia,AML)患者中的表达水平及其临床意义。方法:选取2017年10月至2019年1月本院收治的200例AML患者为研究对象,分为初治组(n=124)、缓解组(n=39)和复发组(n=37)。用酶联免疫吸附试验检测入组时血清Flt3L表达水平。对初治组患者进行为期1年的随访,根据生存预后分为存活组(n=96)和死亡组(n=28)。AML患者不良生存预后的影响因素用Cox多因素分析,采用受试者工作特征(ROC)曲线分析Flt3L预测预后的价值。结果:初治组血清Flt3L质量浓度为(83.09±12.09)pg·ml^(-1),复发组为(91.76±20.23)pg·ml^(-1),均低于缓解组的(133.08±30.24)pg·ml^(-1)(均P<0.001),而初治组与复发组差异有统计学意义(P<0.001)。存活组血清Flt3L质量浓度为(88.07±11.82)pg·ml^(-1),高于死亡组的(78.07±10.09)pg·ml^(-1),但差异无统计学意义(t=1.372,P>0.05)。血清Flt3L(OR=0.897)是AML患者死亡的独立影响因素(P<0.05)。血清Flt3L预测AML患者1年内死亡的ROC曲线下面积(AUC)为0.823(P=0.031);当血清Flt3L截断值为75.08 pg·ml^(-1)时,约登指数最大(0.625),此时血清Flt3L预测AML患者死亡预后的价值最高,灵敏度为84.15%,特异度为79.83%。结论:血清Flt3L对AML患者病情及预后早期评价有一定价值。

Objective:To explore the expression and significance of serum FMS like tyrosine kinase 3 ligand(Flt3L)in patients with acute myeloid leukemia(AML).Methods:200 patients with AML admitted between October 2017 and January 2019 were included in the present study,including initial treatment group(n=124),remission group(n=39)and recurrence group(n=37).Enzyme linked immunosorbent assay(ELISA)was used to detect the expression of Flt3L in serum of all patients.According to the survival prognosis,the initial treatment group was further divided into survival group and death group,which had 96 and 28 patients respectively.Cox regression model and ROC curve were used to analyze the prognostic value of AML patients.Results:The serum Flt3L concentration in the initial treatment group was(83.09±12.09)pg·ml^(-1),and that in the recurrence group was(91.76±20.23)pg·ml^(-1),which was lower than that in the remission group(133.08±30.24)pg·ml^(-1)(P<0.001).There was statistically significant between the initial treatment group and the recurrence group(P<0.001).The serum Flt3L concentration in survival group was(88.07±11.82)pg·ml^(-1),which was higher than(78.07±10.09)pg·ml^(-1) in death group but there was no significant difference between the two groups(t=1.372,P>0.05).Serum Flt3L(OR=0.897)was an independent factor influencing the death of AML patients(P<0.05).The AUC of serum Flt3L was 0.823(P=0.031).When the Cut-off value of serum Flt3L was 75.08 pg·ml^(-1),the Youden index was the highest(0.625).At this time,the value of serum Flt3L in predicting the death prognosis of AML patients was the highest,with a sensitivity of 84.15%and a specificity of 79.83%.Conclusion:Serum Flt3L is valuable for early evaluation of AML patients'condition and prognosis.