血浆纤维蛋白原水平与非M3型急性髓性白血病患者的预后和疗效的相关性研究

张素芳; 李华

doi:10.13201/j.issn.1004-2806.2020.01.013

血浆纤维蛋白原水平与非M3型急性髓性白血病患者的预后和疗效的相关性研究

张素芳¹,
李华^2, ,

- 榆林市第一医院血液科(陕西榆林, 719000);
- 2. 榆林市第一医院肾病风湿免疫科

详细信息

通讯作者: 李华,E-mail:lihuass2227@163.com

中图分类号: R733.71

收稿日期: 2019-03-26

Correlation between plasma fibrinogen levels and prognosis in patients with non-M3 acute myeloid leukemia

ZHANG Sufang¹,
LI Hua^2, ,

- 1 Department of Hematology, Yulin First Hospital, Yulin, 719000, China;
- 2 Department of Nephropathy, Rheumatism and Immunology, Yulin First Hospital

More Information

Corresponding author: LI Hua, E-mail: lihuass2227@163.com

Received Date: 26 March 2019

摘要

摘要: 目的:探讨血浆纤维蛋白原(Fg)水平在预测非M3型急性髓性白血病(AML)的生存预后和诱导化疗疗效的临床价值。方法:回顾性分析215例初治非M3型AML患者的血浆Fg水平和化疗疗效,根据ROC曲线确定Fg阈值,比较不同Fg水平的非M3型AML患者的总生存期(OS)和无病生存期(DFS)差异,并确定影响非M3型AML患者OS和DFS的独立危险因素。结果:ROC曲线确定AML患者Fg水平高低分组临界值为3.8 g/L,共有114例患者Fg＜3.8 g/L,101例患者Fg≥3.8 g/L。与Fg＜3.8 g/L患者相比,Fg≥3.8 g/L患者的诱导化疗后的完全缓解(CR)率更低(70.3%vs 86.0%,P=0.005),但复发率更高(44.6%vs 29.8%,P=0.025)。而CR患者的血浆Fg水平显著低于未达到CR患者的血浆Fg水平[(3.6±1.1) g/L vs (4.1±1.2) g/L,P=0.009]。复发患者的血浆Fg水平显著高于未复发患者的血浆Fg水平[(4.3±1.5) g/L vs (3.7±1.2) g/L,P=0.001]。与Fg＜3.8 g/L患者相比,Fg≥3.8 g/L患者的DFS和OS均明显缩短(均P＜0.001)。单因素及多因素Cox回归分析显示,年龄≥60岁(HR=1.239,95%CI 1.113~1.496,P=0.005)、TT＜16 s(HR=1.288,95%CI 1.139~1.871,P=0.046)和Fg≥3.8 g/L(HR=1.763,95%CI 1.399~2.984,P=0.003)是影响非M3型AML患者DFS缩短的独立危险因素;而年龄≥60岁(HR=1.223,95%CI 1.074~1.532,P=0.026)、血红蛋白＜100 g/L(HR=1.654,95%CI 1.234~2.273,P=0.025)和Fg≥3.8 g/L(HR=2.134,95%CI 1.238~3.943,P=0.010)是影响非M3型AML患者OS缩短的独立危险因素。结论:初治非M3型AML患者治疗前血浆Fg水平可作为预测OS和DFS的独立危险因素,也可有效预测诱导化疗疗效和复发风险。
- 急性髓性白血病 /
- 纤维蛋白原 /
- 总生存期 /
- 无病生存期 /
- 复发
Abstract: Objective:To investigate the clinical value of fibrinogen(Fg) level in predicting the survival prognosis and induction chemotherapy effects of non-M3 acute myeloid leukemia(AML).Method:The plasma Fg levels and chemotherapy effects of 215 patients with newly diagnosed non-M3 AML were retrospectively analyzed.The Fg threshold was determined by ROC curve analysis.The overall survival(OS) and disease-free survival(DFS) of non-M3 AML patients with different Fg levels were compared,and independent risk factors for OS and DFS in non-M3 AML patients were identified by Cox regression analysis.Result:The ROC curve determined that the cut-off value of Fg level in AML patients was 3.8 g/L.There were 114 patients with Fg＜3.8 g/L and 101 patients with Fg≥3.8 g/L.Comparing to patients with Fg＜3.8 g/L,patients with Fg≥3.8 g/L had a lower complete response(CR) rate after induction chemotherapy(70.3% vs 86.0%,P=0.005),but had higher recurrence rate(44.6% vs 29.8%,P=0.025).The plasma Fg levels in CR patients was significantly lower than that in patients without CR [(3.6±1.1) g/L vs(4.1±1.2) g/L,P=0.009].Plasma Fg levels in relapsed patients were significantly higher than that in patients without recurrence [(4.3±1.5) g/L vs(3.7±1.2) g/L,P=0.001].Comparing to patients with Fg＜3.8 g/L,DFS and OS were significantly shorter in patients with Fg≥3.8 g/L(both P＜0.001).Univariate and multivariate Cox regression analysis showed age≥60 years(HR=1.239,95%CI 1.113-1.496,P=0.005),TT＜16 s(HR=1.288,95%CI 1.139-1.871,P=0.046) and Fg≥3.8 g/L(HR=1.763,95%CI 1.399-2.984,P=0.003) were independent risk factors for poor DFS in non-M3 AML patients;age≥60 years(HR=1.223,95%CI 1.074-1.532,P=0.026),hemoglobin＜100 g/L(HR=1.654,95%CI 1.234-2.273,P=0.025)and Fg≥3.8 g/L(HR=2.134,95%CI 1.238-3.943,P=0.010)were independent risk factors for poor OS in non-M3 AML patients.Conclusion:Baseline plasma Fg levels in patients with newly diagnosed non-M3 AML can be used as independent risk factors for predicting OS and DFS,and can also effectively predict the efficacy of induction chemotherapy and the risk of recurrence.
- acute myeloid leukemia /
- fibrinogen /
- overall survival /
- disease-free survival /
- recurrence

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