摘要
目的探讨初诊免疫性血小板减少症(ITP)经糖皮质激素(GC)治疗失败的影响因素。方法回顾性选取2018年1月至2020年12月期间保定市第一医院血液科初诊ITP并接受规范GC治疗的82例患者作为训练集,并依据治疗结果分为成功组(46例)和失败组(36例);按相同标准选取2021年1月至2021年7月收治的患者40例作验证集。比较成功组和失败组患者临床资料,多因素logistic回归分析影响初诊ITP患者经GC治疗失败的危险因素,建立列线图预测模型并评价。结果成功组与失败组患者年龄、性别、血小板(PLT)计数、白细胞介素-17(IL-17)、P-糖蛋白(P-gp)、CD4+T淋巴细胞、骨髓巨核细胞计数、血清抗核抗体(ANA)、PLT相关抗体、中性粒细胞碱性磷酸酶(NAP)阳性率比较差异有统计学意义(均P<0.05)。IL-17水平(OR=2.336,95%CI:1.452~4.165,P=0.005)、P-gp表达水平(OR=3.723,95%CI:1.224~5.118,P=0.013)、骨髓巨核细胞数(OR=4.778,95%CI:3.178~5.889,P=0.028)、PLT相关抗体表达(OR=0.347,95%CI:0.133~0.938,P=0.031)为GC治疗失败的独立影响因素(均P<0.05)。训练集和验证集列线图模型的C-index计算结果分别为0.822(95%CI:0.735~0.891)、0.809(95%CI:0.711~0.856),ROC曲线下面积分别为0.815(95%CI:0.745~0.902)、0.843(95%CI:0.733~0.887),列线图模型的临床决策曲线阈值概率在0.01~0.95范围内,净获益率>0。结论IL-17水平升高、P-gp高表达、骨髓巨核细胞数减少、PLT相关抗体阳性是GC治疗失败的独立影响因素。
Objective To explore the influencing factors of failure to receive glucocorticoid(GC)treatment for newly diagnosed immune thrombocytopenia(ITP).Methods A retrospective selection was made of 82 patients who were initially diagnosed with ITP in the Hematology Department of the First Hospital of Baoding from January 2018 to December 2020 and received standardized GC treatment as the training set.They were divided into a success group(46 cases)and a failure group(36 cases)based on treatment results;Forty patients admitted from January 2021 to July 2021 were selected as the validation set according to the same criteria.We compared the clinical data of patients in the successful and failed groups,analyzed the risk factors for GC treatment failure in newly diagnosed ITP patients through multiple logistic regression,established a column chart prediction model,and evaluated it.Results There were statistically significant differences in age,gender,platelet(PLT)count,interleukin-17(IL-17),P-glycoprotein(P-gp),CD4+T lymphocytes,bone marrow megakaryocyte count,serum antinuclear antibody(ANA),PLT related antibodies,and neutrophil alkaline phosphatase(NAP)positivity rates between the successful and failed groups of patients(all P<0.05);IL-17 levels(OR=2.336,95%CI:1.452-4.165,P=0.005),P-gp expression levels(OR=3.723,95%CI:1.224-5.118,P=0.013),bone marrow megakaryocyte count(OR=4.778,95%CI:3.178-5.889,P=0.028),and PLT related antibody expression(OR=0.347,95%CI:0.133-0.938,P=0.031)were independent influencing factors for GC treatment failure(all P<0.05).The C-index calculation results of the training set and validation set column chart models were 0.822(95%CI:0.735-0.891)and 0.809(95%CI:0.711-0.856),respectively.The area under the receiver operating characteristic(ROC)curve is 0.815(95%CI:0.745-0.902)and 0.843(95%CI:0.733-0.887),respectively.The clinical decision curve threshold probability of the column chart model is within the range of 0.01-0.95,and the net benefit rate was>0.Conclusions Elevated L-17 levels,high expression of P-gp,decreased number of bone marrow megakaryocytes,and positive PLT related antibodies are independent influencing factors for GC treatment failure.
作者
李影
王芳
黄娇
Li Ying;Wang Fang;Huang Jiao(Department of Pharmacy,the First Hospital of Baoding,Baoding 071000,China)
出处
《中国医师杂志》
CAS
2023年第12期1800-1805,共6页
Journal of Chinese Physician
基金
河北省药学会医院药学专项科研项目(2022-Hbsyxhms-08)。
