C反应蛋白与血清白蛋白比值对急性髓性白血病老年患者预后的评估

Prognostic Evaluation of C-reactive Protein/Serum Albumin Ratio in Elderly Patients with Acute Myeloid Leukemia

目的探讨C反应蛋白与血清白蛋白比值(CAR)对急性髓性白血病老年患者预后的评估价值。方法选取2018年2月—2022年12月徐州医科大学附属医院诊断的84例非M3急性髓性白血病老年患者进行回顾性分析。根据ROC曲线确定CAR最佳截断点,将患者分为低CAR组和高CAR组,比较各组间临床指标的差异,采用Kaplan-Meier法绘制生存曲线,采用COX比例风险回归模型进行预后因素分析。结果根据ROC计算CAR的AUC为0.870(95%CI:0.788~0.953,P<0.05),根据约登指数计算CAR最佳截断值为0.370,灵敏度为86.2%,特异度为81.8%。CAR≤0.370的35例为低CAR组,CAR>0.370的49例为高CAR组。高CAR组中C反应蛋白水平更高(P<0.05),血清白蛋白水平更低(P<0.05),低CAR组患者诱导化疗后更容易实现首次完全缓解(P<0.05)。低CAR组的总生存期及无进展生存期均优于高CAR组,差异均有统计学意义(P<0.05)。COX比例风险回归模型显示,CAR是影响老年急性髓性白血病患者预后的独立危险因素(P<0.05)。结论较高的CAR值提示非M3急性髓性白血病老年患者的预后更差,CAR可能成为此类患者预后评价的有效标志物。

Objective To investigate the value of C-reactive protein to serum albumin ratio(CAR)in evaluating the prognosis of elderly patients with acute myeloid leukemia.Methods A retrospective analysis was performed on 84 elderly patients with non-M3 acute myeloid leukemia diagnosed in the Affiliated Hospital of Xuzhou Medical University from February 2018 to December 2022.According to the ROC curve,the optimal cut-off point of CAR was determined,and the patients were divided into a low CAR group and high CAR group.The differences of clinical indexes between the groups were compared.The survival curve was drawn by the Kaplan-Meier method,and the prognostic factors were analyzed by the COX proportional hazard regression model.Results According to ROC,the AUC of CAR was 0.870(95%CI:0.788-0.953,P<0.05),The optimal cutoff value for CAR was 0.370 as calculated based on the Youden index,with a sensitivity of 86.2%and a specificity of 81.8%.The patients which CAR≤0.370 were the low CAR group and 49 patients with CAR>0.370 were in the high CAR group.In the high CAR group,the C-reactive protein value was higher(P<0.05),and the serum albumin value was lower(P<0.05).The patients in the low CAR group were more likely to achieve the first complete remission after induction chemotherapy(P<0.05).The overall survival and progression-free survival of the low CAR group were better than those of the high CAR group,and the differences were statistically significant(P<0.05).COX proportional hazard regression model showed that CAR was an independent risk factor affecting the prognosis of elderly patients with acute myeloid leukemia(P<0.05).Conclusion The higher CAR value suggests that the prognosis of elderly patients with non-M3 acute myeloid leukemia is worse,and CAR may be an effective marker for the prognosis rating of such patients.