促肾上腺皮质激素在初诊急性髓系白血病患者中的预后价值分析
Prognostic Value of Adrenocorticotropic Hormone in Patients with Newly Diagnosed Acute Myeloid Leukemia
丁林林 1赵苗苗 1刘文洁 1孙倩 1洪鸣 1钱思轩1
作者信息
- 1. 210029 南京医科大学第一附属医院血液科
- 折叠
摘要
目的 探讨初诊急性髓系白血病(acute myeloid leukemia,AML)患者促肾上腺皮质激素(adrenocorticotropic hor-mone,ACTH)水平的临床特征及预后意义.方法 回顾性分析2015年1月～2021年10月连续收治的235例初诊AML患者的临床资料及生存情况,采用Kaplan-Meier法绘制ACTH组间生存曲线.采用COX回归分析筛选影响患者生存的危险因素,R软件构建预后模型后采用校准曲线进行验证.结果 在235例AML患者中,ACTH低于7.2pg/ml者40例.Kaplan-Meier生存曲线分析结果提示,低ACTH组患者生存时间明显缩短.单因素COX回归分析结果显示,年龄、欧洲白血病网(European Leukemia Net,ELN)预后分型、美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分、ACTH水平与患者预后不良相关(P＜0.05).多因素COX回归分析结果显示,年龄、ELN预后分层、ECOG评分、ACTH水平是患者生存的独立影响因素(P＜0.05).利用这4个变量构建了预测总生存期的列线图并建立概率校准图,显示模型的校正曲线与标准曲线接近,表现出良好的线性关系.结论 ACTH水平低下是AML患者生存的独立不良预后因素,基于年龄、ELN预后分层、ECOG评分、ACTH水平这4个变量构建的列线图有较好的预测价值.
Abstract
Objective To explore the clinical characteristics and prognostic significance of adrenocorticotropic hormone(ACTH)level in patients with acute myeloid leukemia(AML).Methods A total of 235 AML patients were enrolled from January 2015 to October 2021.The survival curves between ACTH groups were drawn by Kaplan-Meier.The risk factors of overall survival(OS)were analyzed by COX regression analysis.The prognostic model was constructed by R software and verified by calibration curve.Results Among 235 AML patients,the ACTH level of 40 patients were lower than 7.2pg/ml.Kaplan-Meier survival curve analysis indicated that the survival time of patients with low ACTH was significantly shortened.Univariate analysis showed that age,prognosis classification of European Leu-kemia Net(ELN),Eastern Cooperative Oncology Group(ECOG)score,and ACTH were correlated with poor survival in AML patients(P＜0.05).Multivariate COX regression analysis showed that age,prognosis classification of ELN,ECOG score,and ACTH level were the independent factors for patient survival(P＜0.05).A nomogram and calibration curves for predicting overall survival were construc-ted using these factors,which showed that the calibration curve of the model was close to the standard curve,showing a good linear rela-tionship.Conclusion Low ACTH level is an independent prognostic factor for survival in AML patients,and a model of nomogram con-structed based on age,prognostic classification of ELN,ECOG score and ACTH level has a good predictive value.
关键词
促肾上腺皮质激素/急性髓系白血病/危险因素/列线图模型Key words
Adrenocorticotropic hormone/Acute myeloid leukemia/Risk factors/Nomogram model引用本文复制引用
出版年
2024
NETL
NSTL
万方数据