NLR联合血清β2-MG、TGF-β1对急性髓系白血病的预后分析价值

Prognostic value of NLR combined with serum β2-MG and TGF-β1 for acute myeloid leukemia

目的:探讨外周血中性粒细胞/淋巴细胞比值(NLR)、血清β2微球蛋白(β2-MG)及转化生长因子β1(TGF-β1)联合检测在急性髓系白血病(AML)患者预后分析中的应用价值。方法:收集2015年7月—2017年7月收治的60例AML患者(AML组),另收集同期性别、年龄匹配的42例健康体检者作为对照组。于治疗前采集所有患者清晨静脉血检测血常规及血清β2-MG、TGF-β1水平;所有AML患者治疗后随访3年,分析NLR及血清β2-MG、TGF-β1水平与无病生存期(DFS)的关系。结果:AML组NLR及血清β2-MG水平均显著高于对照组(P<0.05),TGF-β1水平显著低于对照组(P<0.05);Kaplan-Meier生存分析显示,TGF-β1高水平组整体生存情况优于TGF-β1低水平组,β2-MG高水平组及NLR高水平组整体生存情况分别差于β2-MG低水平组及NLR低水平组(P<0.05);COX多因素回归分析提示,非急性早幼粒细胞白血病、高NLR水平、高β2-MG水平及高TGF-β1水平是AML患者DFS的独立危险因素(P<0.05);ROC曲线分析显示,NLR、β2-MG、TGF-β1三者联合预测AML患者预后不良的AUC分别大于NLR、β2-MG与TGF-β1单独预测的AUC(P<0.05)。结论:治疗前NLR及血清β2-MG高水平、血清TGF-β1低水平是AML患者DFS的独立危险因素,三者联合检测能较好地预测AML患者预后。

Objective: To explore the application value of peripheral blood neutrophil/lymphocyte ratio(NLR), serum β2 microglobulin(β2-MG) and transforming growth factor β1(TGF-β1) detection in the prognosis analysis of patients with acute myeloid leukemia(AML). Methods: A total of 60 AML patients admitted to our hospital from July 2015 to July 2017 were enrolled as AML group, while another 42 healthy controls with matched genders and age during the same period were enrolled as control group. The venous blood in the morning was collected from all patients before treatment to test blood routine and levels of serum β2-MG and TGF-β1. All AML patients were followed up for 3 years after treatment. The relationship between NLR, serum β2-MG, TGF-β1 levels and disease-free survival(DFS) was analyzed. Results: NLR and level of serum β2-MG in AML group were significantly higher than those in control group(P<0.05), while TGF-β1 level was significantly lower than that in control group(P<0.05). Kaplan-Meier survival analysis showed that overall survival in high-level TGF-β1 group was better than that in low-level TGF-β1 group. The overall survival in high-level β2-MG group and high-level NLR group was worse than that in low-level β2-MG group and low-level NLR group, respectively(P<0.05). COX multivariate regression analysis indicated that non-acute promyelocytic leukemia, high levels of NLR, β2-MG and TGF-β1 were independent risk factors of DFS in AML patients(P<0.05). ROC curve analysis showed that AUC of NLR combined with β2-MG and TGF-β1 for predicting poor prognosis of AML patients was greater than that of them alone(P<0.05). Conclusion: High levels of NLR and serum β2-MG, and low level of serum TGF-β1 before treatment may be independent risk factors of DFS in AML patients. The combined detection of the three can better predict the prognosis of AML patients.