Construction of clinical prediction model for the changes of T lymphocyte subsets and efficacy in the treatment of aplastic anemia with the method of nourishing kidney and engendering blood and the method of boosting qi and nourishing blood
Objective:To investigate the characteristics of T lymphocyte subpopulation changes in patients with aplastic anemia(AA)treated mainly by the method of nourishing kidney and engendering blood and the method of boosting qi and nourishing blood and to construct a multifactorial assessment model for efficacy prediction.Methods:Clinical data of patients in a prospective,multicenter,randomized controlled trial were retrospectively collected,including treatment subgroups,gender,comorbidities,age,disease age,HGB,PLT,WBC,ANC,and various T lymphocyte subsets.According to the Diagnostic and Efficacy Criteria for Hematological Diseases,the efficacy of AA patients after 6 months of treatment was evaluated,'effective'and'ineffective'were used as the dependent varivables,and the indexes affecting treatment efficiency were screened out by univariate and multivariate Logistic regression analysis,and prediction models were constructed according to the results of regression equations and their predictive efficacy was analyzed.Results:A total of 277 AA patients'clinical data were included for analysis,including 136 cases in the group of nourishing kidney and engendering blood,141 cases in the group of boosting qi and nourishing blood,and a total of 219 cases were evaluated as effective and 58 cases were ineffective in treatment after 6 months of treatment.After including 18 relevant indexes in the univariate analysis,the independent variables with P＜0.1 were then entered into the multivariate Logistic analysis,and the treatment grouping was set as dummy variables for the group of boosting qi and nourishing blood,the group of nourishing kidney and engendering blood(P＜0.00l,OR=2.88,95％CI[1.50,5.74],PLT(P=0.03,OR=1.01,95％CI[1.00-1.02],CD3+CD8+(P=0.04,OR=1.02,95％CI[1.00,1.05])were protective factors for predicting efficacy.Based on the results,the nomogram model of efficacy prediction was generated using R 4.1.3 sofeware.The AUC of the ROC of the nomogram model was 0.71,95％CI[0.63,0.78],the calibration curve and the standard curve of the internal validation of the model were relatively close,the degree of coincidence was high,and the degree of fit was good.The Hosmer-Lemeshow goodness of fit test was good for model consiseency(x2=4.02,P=0.86).Conclusion:CD3+CD8+in T lymphocyte subsets is an important factor affecting the efficacy of AA,and the nomogram model established by combining traditional Chinese medicine treatment grouping and PLT can be used to predict the efficacy of integrated traditional Chinese and Western medicine in the treatment of AA patients.
Aplastic anemia(AA)T lymphocytesMethod of nourishing kidney and engendering bloodMethod of boosting qi and nourishing bloodIntegrated Chinese and Western medicineClinical prediction modelNomogram
NETL
NSTL
万方数据
