[小儿急性白血病诱导缓解期的炎症指标]

[Inflammatory indexes during remission induction of pediatric acute leukemia].

作者信息

Torres-García Juan Carlos, Paque-Bautista Carlos, González Alma Patricia, Martínez-Villegas Octavio, Sosa-Bustamante Gloria Patricia

机构信息

Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Gineco Pediatría No. 48, Dirección de Educación e Investigación en Salud. León, Guanajuato, México.

Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Gineco Pediatría No. 48, Departamento de Hematología Pediátrica. León, Guanajuato, México.

出版信息

Rev Med Inst Mex Seguro Soc. 2023 Sep 18;61(Suppl 2):S329-S336.

PMID:38016441

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11967958/

Abstract

BACKGROUND

Inflammatory indexes can reflect the severity of serious diseases such as acute leukemia (AL), which is why they can predict mortality.

OBJECTIVE

To evaluate the prognostic value of mortality of inflammatory indexes during the remission induction stage in patients with pediatric AL.

MATERIAL AND METHODS

Observational, longitudinal, analytical and retrolective study. Patients aged 0 to 17 years, with a recent and confirmed diagnosis of AL, who had basal (at diagnosis, before the start of treatment) and final (at the end of remission induction, or, in the cases of death, during the period prior to this outcome) complete blood count were included.

RESULTS

We included 78 patients, 67 with acute lymphoblastic leukemia (ALL), and 11 with acute myeloblastic leukemia (AML), with 11 and 2 deaths, respectively. Regarding ALL, no index showed significant cut-off points to distinguish deaths. Concerning AML, the indices whose cut-off points distinguished the patients who died in the basal measurement, were the monocyte-lymphocyte ratio (MLR) ≥ 3.11 (sensitivity [Se] 100%, specificity [Sp] 66.67%, AUC 0.8333, p 0.03), and, at the final measurement, the neutrophil-lymphocyte ratio (NLR) ≥ 1.30 and MLR ≥ 0.57 (both with Se 100% and Sp 88.89%, AUC 1.0, p < 0.00001) and systemic immune index (SII) ≥ 246612 (Se 100%, Sp 88.89%, AUC 0.9444, p < 0.0001). With bivariate analysis, only the latter demonstrated an increase in the risk of mortality (p = 0.02).

CONCLUSIONS

The basal MLR and the final NLR, MLR and SII are prognostic inflammatory indices of mortality in patients with AML undergoing remission induction.

摘要

背景

炎症指标能够反映诸如急性白血病（AL）等严重疾病的严重程度，这就是它们能够预测死亡率的原因。

目的

评估小儿急性白血病患者缓解诱导期炎症指标对死亡率的预后价值。

材料与方法

观察性、纵向、分析性及回顾性研究。纳入年龄在0至17岁、近期确诊为急性白血病且有基础（诊断时，治疗开始前）及最终（缓解诱导结束时，或在死亡病例中，在该结局发生前的时期）全血细胞计数的患者。

结果

我们纳入了78例患者，其中67例为急性淋巴细胞白血病（ALL），11例为急性髓细胞白血病（AML），分别有11例和2例死亡。关于ALL，没有指标显示出区分死亡病例的显著临界点。对于AML，在基础测量中其临界点能够区分死亡患者的指标有单核细胞 - 淋巴细胞比值（MLR）≥3.11（敏感性[Se]100%，特异性[Sp]66.67%，曲线下面积[AUC]0.8333，p = 0.03），在最终测量中，中性粒细胞 - 淋巴细胞比值（NLR）≥1.30及MLR≥0.57（两者Se均为100%，Sp均为88.89%，AUC为1.0，p < 0.00001）以及全身免疫指数（SII）≥246612（Se 100%，Sp 88.89%，AUC 0.9444，p < 0.0001）。经双变量分析，只有后者显示出死亡率风险增加（p = 0.02）。