Li Shan-Shan, Yang Xue-Wei, Zheng Yu, Gao Yu-Juan, Su Yan-Hua
Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin 150007, Heilongjiang Province, China.
Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin 150007, Heilongjiang Province, China.E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2023 Oct;31(5):1340-1344. doi: 10.19746/j.cnki.issn.1009-2137.2023.05.014.
To further explore the better indicators for predicting the degree of bleeding associated with newly diagnosed acute promyelocytic leukemia (APL).
A total of 131 patients with newly diagnosed APL were classified according to WHO bleeding scales before treatment and divided into two groups: scales 0, 1 and 2 were included in no severe bleeding group, scales 3 and 4 were included in severe bleeding group. The information of the patients were collected, including sex, age, hemoglobin (Hb), white blood cell (WBC) count and platelet (PLT) count, peripheral blood lymphocyte percentage (LYMPH%), peripheral blood monocyte percentage (MONO%), percentage of leukemic cells in pripheral blood and bone marrow, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) levels, D-dimer (D-D), D-dimer/fibrinogen ratio (DFR).
Among 131 patients, 110 were classified as no severe bleeding, and 21 were severe bleeding. The results of univariate analysis showed that patients with severe bleeding had significantly higher percentage of leukemic cells in pripheral blood, WBC, D-D, and DFR, as well as longer PT and lower LYMPH%, compared to those with no severe bleeding. Multivariate analysis revealed that DFR ( =1.054, 95% : 1.024-1.084, < 0.001) and percentage of peripheral blood leukemic cells (=1.026, 95%: 1.002-1.051, =0.033) were independent risk factors for severe bleeding. The area under ROC curve (AUC) of peripheral blood leukemic cells, D-D and DFR were 0.748, 0.736 and 0.809, respectively. There was no statistical difference between the peripheral blood leukemic cells and D-D in diagnostic efficacy ( =0.8708). Compared with D-D, DFR had a higher predictive value ( =0.0302). The optimal cut-off value of DFR was 16.50, with a sensitivity of 90.5% and a specificity of 70.0%.
DFR has a significant advantage in predicting the degree of bleeding associated with newly diagnosed APL. The greater the DFR value, the heavier the degree of bleeding. The risk of severe or fatal bleeding increases when DFR is greater than 16.50.
进一步探索预测新诊断急性早幼粒细胞白血病（APL）出血程度的更佳指标。
131例新诊断的APL患者在治疗前根据WHO出血量表进行分类，分为两组：量表0、1和2纳入无严重出血组，量表3和4纳入严重出血组。收集患者的信息，包括性别、年龄、血红蛋白（Hb）、白细胞（WBC）计数、血小板（PLT）计数、外周血淋巴细胞百分比（LYMPH%）、外周血单核细胞百分比（MONO%）、外周血和骨髓中白血病细胞百分比、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）水平、D-二聚体（D-D）、D-二聚体/纤维蛋白原比值（DFR）。
131例患者中，110例分类为无严重出血，21例为严重出血。单因素分析结果显示，与无严重出血的患者相比，严重出血患者的外周血白血病细胞百分比、WBC、D-D和DFR显著更高，PT更长，LYMPH%更低。多因素分析显示，DFR（=1.054，95%可信区间：1.024 - 1.084，P < 0.001）和外周血白血病细胞百分比（=1.026，95%可信区间：1.002 - 1.051，P = 0.033）是严重出血的独立危险因素。外周血白血病细胞、D-D和DFR的ROC曲线下面积（AUC）分别为0.748、0.736和0.809。外周血白血病细胞和D-D在诊断效能上无统计学差异（P = 0.8708）。与D-D相比，DFR具有更高的预测价值（P = 0.0302）。DFR的最佳截断值为16.50，灵敏度为90.5%，特异度为70.0%。
DFR在预测新诊断APL的出血程度方面具有显著优势。DFR值越大，出血程度越重。当DFR大于16.50时，严重或致命出血的风险增加。
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