血浆IL-1β、IL-8和临床因素对儿童肿瘤患者血小板输注无效的预测价值研究

Predictive value of plasma IL-1β,IL-8 levels and clinical factors for platelet transfusion refractoriness in patients with pediatric cancer

目的探讨化疗相关性血小板减少症(chemotherapy induced thrombocytopenia,CIT)的儿童肿瘤患者临床因素和炎症指标对血小板输注无效(platelet transfusion refractoriness,PTR)的影响并评估其预测价值,为肿瘤患儿由非免疫因素导致PTR发生的机制研究提供基础和为患儿合理有效的输注血小板提供临床指导价值。方法以来自2022年11月至2024年2月间浙江大学医学院附属儿童医院的CIT儿童肿瘤患者共60名为研究对象,分为血小板输注无效组(PTR)和血小板输注有效组(Non-PTR)(各30名),收集其临床资料和血小板(Plt)输注前的实验室数据;采用单因素和多因素Logistic回归分析等方法分析PTR发生的影响因素;通过受试者工作特征(ROC)曲线对影响因素在PTR的预测价值中进行分析。结果PTR组血浆IL-1β浓度显著高于Non-PTR组[67.43 pg/mL(29.38,222.40)vs 36.38 pg/mL(17.27,68.06);P<0.05];PTR组血浆IL-8浓度显著高于Non-PTR组[60.97 pg/mL(39.07,112.00)vs 25.23 pg/mL(5.00,71.38);P<0.01];PTR组起始化疗至Plt输注间隔天数显著高于Non-PTR组[9.5 d(8.0,12.0)vs 12.0 d(9.8,13.2);P<0.05]。多因素逻辑回归分析中,IL-8浓度(OR=1.05,P<0.05)对PTR发生的影响具有统计学意义;ROC曲线分析,血浆IL-1β浓度[Cut-off值:64.88 pg/mL;AUC:0.653(95%CI:0.511~0.796)]、血浆IL-8浓度[Cut-off值:33.33 pg/mL;AUC:0.754(95%CI:0.631~-0.878)]和起始化疗至Plt输注间隔天数[Cut-off值:11.5 d;AUC:0.669(95%CI:0.529~0.810)]对PTR的预测具有统计学意义。结论血浆IL-8浓度是PTR发生的独立危险因素,血浆IL-1β、IL-8浓度和起始化疗至Plt输注间隔天数对PTR发生具有预测价值。

Objective To investigate the effect of clinical factors and inflammatory markers on platelet transfusion refractoriness(PTR)in children with chemotherapy-induced thrombocytopenia(CIT)and evaluate their predictive value,so as to provide reference for mechanism study of PTR caused by non-immune factors in children with cancer and provide clinical guidance for reasonable and effective platelet transfusion in children.Methods A total of 60 CIT pediatric cancer patients from Children’s Hospital,Zhejiang University School of Medicine between November 2022 and February 2024 were selected as the study subjects,and divided into the PTR group(n=30)and the non-PTR group(n=30)to collect the clinical data and laboratory markers before platelet transfusion(Plt).Univariate and multivariate logistic regression analysis was used to analyze the influencing factors of PTR.The predictive value influencing factors of PTR was analyzed by receiver operating characteristic(ROC)curve.Results Plasma IL-1βconcentration in PTR group was significantly higher than that in non-PTR group[67.43 pg/mL(29.38,222.40)vs 36.38 pg/mL(17.27,68.06);P<0.05];plasma IL-8 concentration in PTR group was significantly higher than that in non-PTR group[60.97 pg/mL(39.07,112.00)vs 25.23 pg/mL(5.00,71.38);P<0.01];and the interval from initiation of chemotherapy to platelet transfusion was significantly higher in the PTR group than in the non-PTR group[9.5 d(8.0,12.0)vs 12.0 d(9.8,13.2);P<0.05].Multivariate logistic regression analysis showed that IL-8 concentration(OR=1.05,P<0.05)had a statistically significant effect on the occurrence of PTR.ROC curve analysis showed that plasma IL-1βconcentration(Cut-off value:64.88 pg/mL;AUC:0.653[95%CI:0.511-0.796])and plasma IL-8 concentration(Cut-off value:33.33 pg/mL;AUC:0.754[95%CI:0.631-0.878])and the interval from initiation of chemotherapy to platelet transfusion(Cut-off value:11.5 days;AUC:0.669[95%CI:0.529-0.810])were statistically significant in predicting PTR.Conclusion Plasma IL-8 concentration is an independent risk factor for PTR,and plasma IL-1β,IL-8 concentration and interval from initiation of chemotherapy to platelet transfusion have predictive value for PTR.