Study on correlation between four new coagulation factors and renal function during red blood cell transfusion therapy in patients with acute myeloid leukemia
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摘要: 目的 分析新凝血四项与急性髓系白血病(acute myeloid leukemia，AML)患者红细胞输注治疗期间肾功能的关系。方法 选择2019年6月至2022年5月陕西省人民医院血液科收入的96例AML患者作为研究对象，均接受红细胞输注治疗，以治疗期间发生急性肾损伤(acute kidney injury，AKI)为终点事件。入科后即采血检测患者血常规、凝血四项、新凝血四项、肾功能及一般资料，根据检查结果，分析新凝血四项与AML患者红细胞输注治疗期间发生AKI的关系。结果 研究入选AML患者96例，红细胞输注无效4例，Ⅳ级骨髓抑制2例，最终90例患者作为最终研究对象。90例患者红细胞输注时间为13.00(11.75，14.00)周，22例(24.44%)患者在红细胞输注治疗期间发生AKI。AKI患者红细胞输注次数、红细胞输注量高于N-AKI患者，血浆血栓调节蛋白(TM)、组织型纤溶酶原激活物-抑制剂-1复合物(t-PAIC)、血浆胱抑素C(CysC)表达高于N-AKI患者，血浆凝血酶-抗凝血酶复合物(TAT)、纤溶酶a2纤溶酶抑制剂复合物(PIC)表达低于N-AKI患者，差异有统计学意义(P＜0.05)。采用logistic回归分析发现，红细胞输注次数、血浆TM、t-PAIC表达上调是AML患者红细胞输注治疗期间发生AKI的独立因素(P＜0.05)。绘制ROC曲线，新凝血四项中血浆TM、t-PAIC均能够预测AML患者红细胞输注治疗期间AKI发生。结论 新凝血四项中血浆TM、t-PAIC表达上调是AML患者红细胞输注治疗期间发生AKI的危险因素，红细胞输注治疗前检测血浆TM、t-PAIC有助于预测AKI发生。Abstract: Objective To analyze the relationship between the four new coagulation factors and renal function during red blood cell transfusion therapy in the patients with acute myeloid leukemia(AML).Methods 96 AML patients admitted to Department of Hematology of Shaanxi Provincial People's Hospital from June 2019 to May 2022 were selected as the study subjects, all receiving red blood cell transfusion therapy, with acute kidney injury(AKI) occurring during the treatment period as the endpoint event. After admission, blood samples were collected to test the patient's blood routine, coagulation, new coagulation, renal function, and general information. Based on the examination results, the relationship between new coagulation and AKI during red blood cell transfusion therapy in AML patients was analyzed.Results 96 patients with AML were selected in this study, 4 patients with ineffective red blood cell transfusion, 2 patients with grade IV Bone marrow suppression, and 90 patients were finally selected as the final study subjects. 90 patients underwent red blood cell infusion for 13.00(11.75, 14.00) weeks, and 22 patients(24.44%) developed AKI during red blood cell transfusion therapy. The number and amount of red blood cell transfusion in AKI patients were higher than those in N-AKI patients, the expression of plasma thrombomodulin(TM), tissue type plasmin activator inhibitor 1 complex(t-PAIC) and plasma cystatin C(CysC) were higher than those in N-AKI patients, and the expression of plasma thrombin antithrombin complex(TAT) and plasmin a2 plasmin inhibitor complex(PIC) were lower than those in N-AKI patients, with a statistical significant difference(P<0.05). Logistic regression analysis showed that the number of red blood cell transfusions, the up-regulation of plasma TM and t-PAIC expression were independent factors for AKI during red blood cell transfusion in AML patients(P<0.05). The ROC curve was drawn, and plasma TM and t-PAIC in the new coagulation four items could predict the occurrence of AKI during red blood cell transfusion therapy in AML patients.Conclusion Upregulation of plasma TM and t-PAIC expression in the four new coagulation factors may be a risk factor for AKI in AML patients during red blood cell transfusion therapy. Detection of plasma TM and t-PAIC before red blood cell transfusion therapy could help predict the occurrence of AKI.
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表 1 AML患者一般临床资料
一般资料 AKI(n=22) N-AKI(n=68) t/χ2/Z P 年龄/岁 42.50±8.11 44.65±6.94 1.210 0.230 性别/例(%) 1.828 0.176 男 14(63.64) 32(47.06) 女 8(36.36) 36(52.94) FAB分型/例(%) 2.265 0.687 M0 3(13.64) 11(16.18) M1 5(22.73) 15(22.06) M2 5(22.73) 10(14.71) M4 7(31.82) 18(26.47) M5 2(9.09) 14(20.59) 预后危险度/例(%) 1.474 0.225 预后良好 5(22.73) 25(36.76) 预后中等 17(77.27) 43(63.24) 红细胞输注次数/次 7.50(6.00，8.00) 6.00(5.00，6.00) 4.350 ＜0.001 红细胞输注量/例(%) 8.668 0.003 ≥10 U 16(72.73) 25(36.76) ＜10 U 6(27.27) 43(63.24) WBC/(×109/L) 23.33±5.15 21.86±5.83 1.055 0.294 RBC/(×1012/L) 2.83±0.25 2.92±0.21 1.649 0.103 Hb/(g/L) 46.45±5.12 48.37±5.54 1.430 0.156 TT/s 18.00(17.00，19.00) 18.00(18.00，19.00) 0.980 0.327 PT/s 13.00(12.00，14.00) 13.00(11.25，13.00) 0.814 0.416 APTT/s 32.00(29.75，33.00) 31.00(29.00，33.00) 1.120 0.263 Fib/(g/L) 2.38±0.33 2.52±0.31 1.875 0.064 TM/(TU/mL) 25.16±3.53 20.91±3.06 5.445 ＜0.001 TAT/(ng/mL) 2.02±0.24 2.16±0.25 2.352 0.021 t-PAIC/(ng/mL) 11.27±2.08 8.82±1.82 5.296 ＜0.001 PIC/(μg/mL) 4.37±0.63 4.80±0.81 2.550 0.014 Scr/(μmol/L) 82.36±6.64 80.58±8.13 1.032 0.308 BUN/(mmol/L) 5.13±1.13 5.35±0.94 0.910 0.365 CysC/(mg/L) 6.77±1.22 6.12±1.15 2.264 0.026 β2-MG/(mg/L) 3.13±0.36 2.97±0.25 1.918 0.066 
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表 2 新凝血四项与AML患者红细胞输注治疗期间发生AKI的关系
项目 β SE Wald P OR 95%CI 红细胞输注次数 1.051 0.387 7.377 0.007 2.861 1.340~6.110 红细胞输注量 0.038 0.964 0.002 0.968 1.039 0.157~6.877 TM 0.446 0.153 8.478 0.004 1.563 1.157~2.110 TAT -2.265 1.806 1.573 0.210 0.104 0.003~3.578 t-PAIC 0.959 0.339 7.996 0.005 2.609 1.342~5.072 PIC -1.066 0.710 2.255 0.133 0.344 0.086~1.384 CysC 0.334 0.442 0.570 0.450 1.396 0.587~3.318 常量 -20.403 7.252 7.915 0.005 - -
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表 3 新凝血四项预测AML患者红细胞输注治疗期间发生AKI的ROC曲线
指标 AUC 95%CI 截断值 特异度 灵敏度 约登指数 TM 0.813 0.705~0.921 22.565 TU/mL 0.735 0.818 0.553 t-PAIC 0.808 0.704~0.912 8.965 ng/mL 0.515 0.818 0.333
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