CART细胞治疗患者住院期间心血管不良事件发生的危险因素分析

Risk factors of major adverse cardiovascular events in patients treated with CART cell during hospitalization

目的:探讨CART细胞治疗患者住院期间发生主要不良心血管事件(MACE)的危险因素。方法:回顾性分析2018年9月—2021年4月于徐州医科大学附属医院接受CART细胞治疗的住院患者155例,其中男90例,女65例。根据MACE发生情况分为事件组34例和非事件组121例。分析两组患者基线资料。使用Cox比例风险回归分析患者发生MACE的影响因素。结果:非MACE组和MACE组在基线治疗使用β受体阻滞剂、血红蛋白(HB)、血小板(PLT)、C反应蛋白(CRP)及白细胞介素(IL-6)水平方面均差异具有统计学意义(均P<0.05),两组在CART细胞治疗后使用类固醇激素、低血压、使用托珠单抗和细胞因子释放综合征(CRS)≥2级方面均差异有统计学意义(均P<0.05)。单因素分析发现基线治疗使用β受体阻滞剂、CART细胞治疗后发生低血压、使用托珠单抗、使用类固醇、CRS≥2级,以及CRP、IL-6、HB、PLT均是MACE发生的影响因素(均P<0.05)。多因素Cox比例风险回归分析CART细胞治疗后发生低血压(HR:3.302,95%CI:1.153~7.971,P<0.05)、CART细胞治疗后CRS≥2级(HR:2.979,95%CI:1.244~7.135,P<0.05)是MACE发生的独立危险因素。χ^(2)检验分析发现,CART细胞治疗后CRS≤1级与CRS≥2级组间MACE发生差异具有统计学意义(13.00%∶64.00%,P<0.05)。Kaplan-Meier生存分析法发现CRS≥2级的患者MACE发生率高于CRS≤1级的患者(P<0.05)。结论:CART细胞治疗后低血压以及CRS≥2级可增加MACE患病风险,在一定程度上可作为CART细胞治疗后患者MACE发生的预测因素。

Objective:To explore the risk factors of major adverse cardiovascular events(MACE)in patients treated with CART cell therapy during hospitalization.Methods:A total of 155 patients underwent CART cell therapy in the Affiliated Hospital of Xuzhou Medical University from September 2018 to April 2021 were analyzed retrospectively,including 90 males and 65 females.According to the occurrence of MACE,34 cases were divided into the event group and 121 cases were divided into the non-event group.The clinical baseline data and laboratory indexes of the two groups were analyzed.Cox proportional hazards regression was used to analyze the risk factors of MACE.Results:There were statistical differences in the use of β-blockers,hemoglobin(HB),platelet(PLT),C-reactive protein(CRP),and leukemia interleukin-6(IL-6)levels before the CART cell therapy,as well as the use of steroid hormones and tocilizumab,CRS≥grade 2,and hypotension after CART cell therapy between the two groups(all P<0.05).Univariate Cox proportional hazards regression analysis showed that the use of β-blockers before CART treatment,hypotension,steroid hormones,and tocilizumab after CART cell therapy,CRS≥grade 2,and CRP,IL-6,HB,PLT were the risk factors of MACE(all P<0.05).Multivariate Cox proportional hazards regression analysis showed that hypotension(HR:3.302,95%CI:1.153 to 7.971,P<0.05)and CRS≥grade 2(HR:2.979,95%CI:1.244 to 7.135,P<0.05)after CART cell therapy were independent risk factors for MACE.χ^(2)-test showed that there was a significant difference in MACE between groups with CRS≤grade 1 and CRS≥grade 2 after CART cell therapy(P<0.05).Kaplan-Meier survival analysis estimated that the incidence of MACE in the group with CRS≥grade 2 was higher than that in CRS≤grade1(13.00%∶64.00%,P<0.05).Conclusion:Hypotension and CRS≥grade 2 after CART cell therapy can increase the risk of MACE,which can be used as predictors of MACE after CART cell therapy to a certain extent.