Yang Wen-rui, Xiong Yuan-yuan, Zhang Li, Jing Li-ping, Zhou Kang, Peng Guang-xin, Li Yang, Ye Lei, Li Yuan, Li Jian-ping, Fan Hui-hui, Song Lin, Zhao Xin, Zhang Feng-kui
Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2013 Aug;34(8):709-13. doi: 10.3760/cma.j.issn.0253-2727.2013.08.015.
To evaluate the value of serum soluble transferrin receptor (sTfR) concentration in predicting early response to immunosuppressive therapy (IST) in severe aplastic anemia (SAA).
Clinical data and hematologic responses of 140 SAA patients treated with rabbit antithymocyte globulin (rATG) combination with cyclosporine in our hospital were retrospectively analyzed. Correlation of pre-IST baseline of sTfR and IST responses was statistically analyzed and receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of sTfR in prediction of early responses.
Serum concentration of sTfR in very SAA (VSAA) patients were significantly lower than SAA and transfusion dependent non-SAA cases (P=0.001). The responders, especially at 3 months, had significantly higher pre- IST baseline of sTfR [median, 0.89 (range, 0.21-2.42) mg/L] than that [median, 0.58 (range, 0.13-1.88) mg/L] of non-responders (P=0.005). The cutoff level of 0.91 mg/L and 0.88 mg/L for predicting responses at 3 and 6 months were established based on the ROC curve, with the degree of accuracy of 65.0% and 60.7% respectively. Multivariate analysis showed that pre-IST baseline of sTfR was the independent factor of predicting response at 3 months (P=0.007) and at 6 months (P=0.021).
As a indicator of bone marrow failure severity, sTfR could predict early response to IST therapy in aplastic anemia.
评估血清可溶性转铁蛋白受体（sTfR）浓度在预测重型再生障碍性贫血（SAA）免疫抑制治疗（IST）早期反应中的价值。
回顾性分析我院140例接受兔抗胸腺细胞球蛋白（rATG）联合环孢素治疗的SAA患者的临床资料和血液学反应。对IST治疗前sTfR基线与IST反应的相关性进行统计学分析，并采用受试者工作特征（ROC）曲线评估sTfR预测早期反应的敏感性和特异性。
极重型再生障碍性贫血（VSAA）患者血清sTfR浓度显著低于SAA患者及输血依赖的非SAA患者（P = 0.001）。反应者，尤其是在3个月时，IST治疗前sTfR基线[中位数，0.89（范围，0.21 - 2.42）mg/L]显著高于无反应者[中位数，0.58（范围，0.13 - 1.88）mg/L]（P = 0.005）。根据ROC曲线确定预测3个月和6个月反应的截断水平分别为0.91 mg/L和0.88 mg/L，准确率分别为65.0%和60.7%。多因素分析显示，IST治疗前sTfR基线是预测3个月（P = 0.007）和6个月（P = 0.021）反应的独立因素。
作为骨髓衰竭严重程度的指标，sTfR可预测再生障碍性贫血患者对IST治疗的早期反应。
