系统性炎症因子、血清铁蛋白、叶酸和维生素B_(12)在急性髓系白血病严重程度及预后中的价值

The value of systemic inflammatory factors,serum ferritin,folic acid and vitamin B_(12) in evaluating the severity and prognosis of acute leukemia

目的 探讨中性粒细胞/淋巴细胞(NLR)、白蛋白/纤维蛋白原(AFR)、血清铁蛋白(SF)、叶酸(FA)、维生素B_(12)(VB_(12))在急性髓系白血病(AML)预后及总生存期(OS)的关系。方法 基于电子病历回顾性统计分析AML临床资料,根据病情特点分为疾病组(原始细胞大于> 5%)64例,缓解组(原始细胞<5%)44例,同时期健康体检者60例做为对照组,分别检测实验对象的血常规、SF、FA、VB_(12)等指标。结果 疾病组NLR、AFR、SF、VB_(12)水平明显高于对照组与治愈组、FA水平明显低于对照组与缓解组(P<0.05);缓解组与对照组NLR、AFR、SF、VB_(12)、FA水平差异无统计学意义(P> 0.05);Cox回归分析显示NLR、SF、VB_(12)升高,叶酸低与疾病严重程度显著相关。NLR曲线下面积最大,为0.863,特异度、敏感度分别为64.7%、88.3%。结论 SF、AFR与NLR是改善总生存期(OS)的独立预后因素;NLR异常可作为AML不良临床预后的独立风险因子。

Objective To investigate the relationship between neutrophil/lymphocyte(NLR), albumin/fibrinogen(AFR),serum ferritin(SF), folic acid(FA) and vitamin B(VB) in the prognosis and overall survival(OS) of acute myeloid leukemia(AML).Methods The clinical data of AML were retrospectively analyzed based on electronic medical records. According to the characteristics of the disease, they were divided into 64 cases in the disease group(primordial cells > 5%), 44 cases in the cure group(primordial cells < 5%), and 60 cases in the same period of physical examination as the control group. Blood routine, SF, FA, VBand other indexes of the subjects were detected respectively.Results The levels of NLR, AFR, SF and VBin the disease group were significantly higher than those in the control group and the cure group, and the levels of FA were significantly lower than those in the control group and the cure group(P< 0. 05);There was no statistical significance on the difference in the levels of NLR, AFR, SF, VBand FA between the cured group and the control group(P> 0. 05);Cox regression analysis showed that the increase of NLR, SF and VB, low folate were significantly correlated with disease severity.The area under the NLR curve was the largest(0. 863), and the specificity and sensitivity were 63. 6% and 88%, respectively.Conclusion SF, AFR and NLR are independent prognostic factors to improve the overall survival(OS);Abnormal NLR can be used as an independent risk factor for poor clinical prognosis of AML.