Yang Wenrui, Wu Zhijie, Zhao Xin, Jing Liping, Zhang Li, Zhou Kang, Peng Guangxin, Li Yang, Ye Lei, Li Yuan, Li Jianping, Fan Huihui, Song Lin, Zhang Fengkui
Institute of Hematology and Blood Diseases Hospital,CAMS & PUMC, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2014 Dec;35(12):1095-9. doi: 10.3760/cma.j.issn.0253-2727.2014.12.010.
To evaluate the prognostic value of residual bone marrow hematopoiesis in severe aplastic anemia (SAA) patients with immunosuppressive therapy (IST).
Clinical data and hematologic responses of 38 SAA patients treated with IST regimen (antithymocyte globulin combined with cyclosporine) in our hospital were retrospectively analyzed. Correlation of pre-IST baseline reticulocyte (Ret), absolute neutrophils count (ANC), soluble transferrin receptor (sTfR) concentration, corrected TPO value and hematologic response rate were statistically analyzed and receiver operating characteristic (ROC) curve was used to estimate the value of Ret, ANC, sTfR, and corrected TPO in predicting early IST response.
Responders to IST had significantly higher pre-IST baseline Ret, ANC, sTfR concentration [19.9(2.7-84.4)×10⁹/L, 0.59(0.12-2.67)×10⁹/L, 0.82(0.22-1.58) mg/L] and lower corrected TPO value [142.9(31.8-1 035.0)] than non-responders 5.1(1.5-23.1)×10⁹/L, 0.20(0.04-1.33)×10⁹/L, 0.45(0.19-0.72)mg/L and 2 335.0(1 308.3-7 771.2). Optimizing parameter cutoff levels obtained from ROC curve was Ret 6.75×109/L, ANC 0.30×109/L, sTfR 0.76 mg/L and corrected TPO 148.6, respectively. Combining the four parameters to predict 6 month hemotologic response showed that all the 7 patients with high Ret, ANC, sTfR and low corrected TPO, while only 1 among those 9 with low Ret, ANC, sTfR and high corrected TPO.
Such parameters evaluating residual bone marrow hematopoiesis as Ret, ANC, sTfR, corrected TPO are practical in predicting early IST response in SAA.
评估残余骨髓造血功能对接受免疫抑制治疗（IST）的重型再生障碍性贫血（SAA）患者的预后价值。
回顾性分析我院38例接受IST方案（抗胸腺细胞球蛋白联合环孢素）治疗的SAA患者的临床资料和血液学反应。对IST治疗前基线网织红细胞（Ret）、绝对中性粒细胞计数（ANC）、可溶性转铁蛋白受体（sTfR）浓度、校正TPO值与血液学反应率之间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Ret、ANC、sTfR和校正TPO在预测IST早期反应中的价值。
与未缓解者相比，IST治疗缓解者治疗前基线Ret、ANC、sTfR浓度[分别为19.9(2.7 - 84.4)×10⁹/L、0.59(0.12 - 2.67)×10⁹/L、0.82(0.22 - 1.58)mg/L]显著更高，校正TPO值[142.9(31.8 - 1 035.0)]更低分别为5.1(1.5 - 23.1)×10⁹/L、0.20(0.04 - 1.33)×10⁹/L、0.45(0.19 - 0.72)mg/L和2 335.0(1 308.3 - 7 771.2)。通过ROC曲线获得的最佳参数临界值分别为Ret 6.75×10⁹/L、ANC 0.30×10⁹/L、sTfR 0.76mg/L和校正TPO 148.6。联合这四个参数预测6个月血液学反应显示，Ret、ANC、sTfR高且校正TPO低的7例患者均有反应，而Ret、ANC、sTfR低且校正TPO高的9例患者中只有1例有反应。
Ret、ANC、sTfR、校正TPO等评估残余骨髓造血功能的参数对预测SAA患者IST早期反应具有实际意义。
