载脂蛋白-A 是基于 ATG 的免疫抑制治疗的重型再生障碍性贫血患者的潜在预后生物标志物：一项单中心回顾性研究。
Apolipoprotein-A is a potential prognostic biomarker for severe aplastic anemia patients treated with ATG-based immunosuppressive therapy: a single-center retrospective study.
机构信息
The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Department of Respiratory Medicine, Haining Traditional Chinese Medical Hospital of Zhejiang Province, Haining, Zhejiang, China.
出版信息
Lipids Health Dis. 2022 Oct 4;21(1):93. doi: 10.1186/s12944-022-01703-0.
BACKGROUND
Anti-thymoglobulin (ATG)-based immunosuppressive treatment (IST) is the standard first-line management for patients with severe AA/very severe AA (SAA/VSAA) and is not suitable for allogeneic stem cell transplantation. The response predictor was not fully investigated.
OBJECTIVE
The present study attempted to explore other characteristics, such as serum lipid changes, during ATG-based IST and analyzed their significance in predicting IST response and survival.
METHODS
A total of 61 newly diagnosed SAA/VSAA patients who received ATG-based IST were enrolled from January 2011 to June 2019. The blood lipid levels, immunoglobulins, and peripheral T lymphocytes were retrospectively collected, and their correlations with IST response, estimated 8.5-year overall survival (OS) and event-free survival (EFS) were analyzed.
RESULTS
The overall response (OR)/complete remission (CR) at 3, 6, and 9 months was 24.6%/6.6%, 52.5%/14.8%, and 65.6%/23.0%, respectively. Based on the 9-month response effect, patients were divided into IST-response (IST-R) and IST-nonresponse (IST-NR) groups. The subgroup baseline characteristics showed that the disease severity grade, absolute neutrophil granulocyte count (ANC), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and apolipoprotein-A (Apo-A) differed between the IST-R and IST-NR groups. Patients with lower Apo-A (< 1.205 g/L) level pretreatment had a better event-free survival (EFS), and a moderate negative correlation was established between the pretreatment Apo-A and 9-month response (P = 0.004). In addition, the T-cell subset and immunoglobulin analyses showed that the responsive patients had a low serum IgA level, which decreased further after therapy. Additionally, a moderate negative correlation was established between the 3-month IgA and 9-month response (P = 0.006).
CONCLUSION
Serum Apo-A is a prognostic biomarker for newly diagnosed < 60-year-old SAA/VSAA patients who received ATG-based IST (registered at chictr.org.cn as # ChiCTR2100052979).
背景
抗胸腺球蛋白（ATG）为基础的免疫抑制治疗（IST）是严重再生障碍性贫血/极严重再生障碍性贫血（SAA/VSAA）患者的标准一线治疗方法，但并不适用于所有异基因干细胞移植。目前尚未充分研究反应预测因子。
目的
本研究试图探讨 ATG 为基础的 IST 期间的其他特征，如血清脂质变化，并分析其在预测 IST 反应和生存方面的意义。
方法
2011 年 1 月至 2019 年 6 月，共纳入 61 例新诊断的 SAA/VSAA 患者，接受 ATG 为基础的 IST。回顾性收集血脂水平、免疫球蛋白和外周 T 淋巴细胞，并分析其与 IST 反应、估计 8.5 年总生存（OS）和无事件生存（EFS）的相关性。
结果
总反应（OR）/完全缓解（CR）在 3、6 和 9 个月时分别为 24.6%/6.6%、52.5%/14.8%和 65.6%/23.0%。基于 9 个月的反应效果，患者被分为 IST 反应（IST-R）和 IST 无反应（IST-NR）组。亚组基线特征显示，疾病严重程度分级、绝对中性粒细胞计数（ANC）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和载脂蛋白-A（Apo-A）在 IST-R 和 IST-NR 组之间存在差异。治疗前 Apo-A 水平较低（<1.205g/L）的患者无事件生存（EFS）更好，治疗前 Apo-A 与 9 个月反应之间存在中度负相关（P=0.004）。此外，T 细胞亚群和免疫球蛋白分析显示，反应性患者的血清 IgA 水平较低，治疗后进一步降低。此外，3 个月 IgA 与 9 个月反应之间存在中度负相关（P=0.006）。
结论
血清 Apo-A 是接受 ATG 为基础 IST 的新诊断<60 岁 SAA/VSAA 患者的预后生物标志物（在中国临床试验注册中心注册，注册号为 ChiCTR2100052979）。
Zotero 插件