异基因造血干细胞移植患者血清铁蛋白水平在移植后血小板减少中的临床意义

Clinical Significance of Pretransplant Serum Ferritin Level in Patients with Prolonged Thrombocytopenia after Allogeneic Hematopoietic Stem Cell Transplantation

目的:探讨血清铁蛋白水平(SF)在异基因造血干细胞移植(allo-HSCT)后血小板减少中的临床意义。方法:回顾性分析本院35例移植后血小板减少患者临床资料及移植情况,并从血小板计数正常的424例患者中按照年龄及性别匹配方式选取35名同时期移植患者作为对照,参照移植前SF水平,通过卡方检验和Fisher精确检验,以及单因素、多因素Logistic回归分析分析危险因素。采用Kaplan-Meier模型估算生存曲线以探讨其临床意义,并应用ROC曲线验证SF的预测效能。结果:移植后血小板减少组与对照组相比,移植前SF水平显著增高(P=0.001)。多因素分析结果显示,移植前SF水平为移植后血小板减少的危险因素。ROC曲线分析表明,SF水平可作为移植后血小板减少的预测指标。SF≥1 000 ng/ml的移植后血小板减少患者有较高的死亡风险(P=0.014)。结论:移植前的SF水平与移植后患者血小板减少的发生与预后相关,检测SF水平可以为移植后血小板减少的干预提供指导。

Objective:To investigate the correlation between pretransplant serum ferritin(SF) level and prolonged or prolonged isolated thrombocytopenia(PT) after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical data of 35 patients with PT after allo-HSCT were retrospectively analyzed,and 35 patients were matched according to age and sex as a controls from 424 allo-HSCT patients with normal platelet count.The serum ferritin level before the transplantation was analyzed.The potential risk factors were analyzed by chi-square test and Fisher ’s exact test as well as univariate and multivariate logistic regression.The survival curve was estimated by the Kaplan-Meier model to explore its clinical significance.In addition,ROC curve was used to verify the predictive power of SF.Results:Compared with control group,the SF level in the PT group before transplantation significantly increased(P=0.001).Multivariate analysis results showed that SF level before transplantation was a risk factor for prolonged thrombocytopenia after HSCT,and patients with SF ≥1000 ng/ml showed a higher risk of death(P=0.014).ROC curve showed that SF level could be used as a predictor of prolonged thrombocytopenia after allo-HSCT.Conclusion:The SF level before allo-HSCT relates with occurrence and prognosis of PT in patients after allo-HSCT.Detection of SF level can provide guidance for the intervention of prolonged thrombocytopenia after HSCT.