细胞因子对初诊急性早幼粒细胞白血病患者早期死亡的影响

Effects of Cytokines on Early Death in Patients with Newly Diagnosed Acute Promyelocytic Leukemia

目的:探索细胞因子对初诊急性早幼粒细胞白血病(APL)患者早期死亡及凝血功能障碍的影响。方法:69例初诊APL患者入院时完善常规检查,采集空腹静脉血4 ml,离心后取上清液,通过相应试剂盒检测细胞因子浓度及铁蛋白、乳酸脱氢酶(LDH)的浓度。结果:本研究证实急性脑血管意外是APL患者早期死亡的主要原因;LDH升高、血小板数(PLT)下降及凝血酶原时间(PT)延长是早期死亡的高危因素(P<0.05);IL-5、IL-6、IL-10、IL-12p70、IL-17A升高与初诊APL患者早期死亡密切相关,IL-5、IL-17A升高引起PT延长诱发凝血障碍(P<0.05);初诊时铁蛋白、LDH对IL-5、IL-10、IL-17A表达有正向影响,尤其是铁蛋白与IL-5(r=0.867)、IL-17A(r=0.841)呈高度正相关;5种高危细胞因子之间也有一定联系,其中IL-5与IL-17A(r=0.827)、IL-6与IL-10(r=0.823)呈高度正相关。结论:初诊APL患者细胞因子水平升高导致早期出血及死亡风险增加。铁蛋白及LDH正向影响细胞因子表达,从而影响APL患者预后,细胞因子之间也相互影响。

Objective:To explore the effect of cytokine levels on early death and coagulation function of patients with newly diagnosed acute promyelocytic leukemia(APL).Methods:Routine examination was performed on 69 newly diagnosed APL patients at admission.Meanwhile,4 ml fasting venous blood was extracted from the patients.And then the supernatant was taken after centrifugation.The concentrations of cytokines,lactate dehydrogenase(LDH)and ferritin were detected by using the corresponding kits.Results:It was confirmed that cerebral hemorrhage was a major cause of early death in APL patients.Elevated LDH,decreased platelets(PLT)count and prolonged prothrombin time(PT)were high risk factors for early death(P<0.05).The increases of IL-5,IL-6,IL-10,IL-12p70 and IL-17A were closely related to the early death of newly diagnosed APL patients,and the increases of IL-5 and IL-17A also induced coagulation disorder in APL patients by prolonging PT(P<0.05).In newly diagnosed APL patients,ferritin and LDH showed a positive effect on the expression of IL-5,IL-10 and IL-17A,especially ferritin had a highly positive correlation with IL-5(r=0.867)and IL-17A(r=0.841).Moreover,there was a certain correlation between these five high-risk cytokines,among which IL-5 and IL-17A(r=0.827),IL-6 and IL-10(r=0.823)were highly positively correlated.Conclusion:Elevated cytokine levels in newly diagnosed APL patients increase the risk of early bleeding and death.In addition to the interaction between cytokines themselves,ferritin and LDH positively affect the expression of cytokines,thus affecting the prognosis of APL patients.