摘要
目的 探讨血浆血栓调节蛋白(TM)、组织型纤溶酶原激活物-纤溶酶原激活抑制物复合物(t-PAIC)及D-二聚体(DD)检测对急性髓系白血病(AML)患者红细胞输注期间急性肾损伤(AKI)发生风险的预测价值,以期为AML患者早期干预和个体化输血治疗提供参考。方法 选取2023年7月—2024年6月陕西省延安市人民医院收治的105例AML患者作为观察组,另选取同期在医院进行体检的健康人群100例作为对照组。根据AKI发生情况将观察组患者分为AKI组(n=26)与无AKI组(n=79)。比较2组研究对象的血浆TM、t-PAIC和DD水平;比较AKI组与无AKI组患者的一般资料,并采用逐步回归分析AML患者红细胞输注期间发生AKI的相关影响因素;绘制受试者工作特征(ROC)曲线,评估血浆TM、t-PAIC和DD检测对AML患者红细胞输注期间发生AKI的预测效能。结果 观察组血浆TM、t-PAIC及DD水平高于对照组,差异均有统计学意义(P<0.05)。105例AML患者红细胞输注期间的AKI发生率为24.76%(26/105)。AKI组与无AKI组患者性别构成、年龄、红细胞计数、白细胞计数、凝血酶时间、凝血酶原时间及血红蛋白、血浆纤维蛋白原、血尿素氮、血肌酐、β2微球蛋白水平比较,差异均无统计学意义(P>0.05);AKI组患者红细胞输注次数大于无AKI组,红细胞输注量≥10 U占比及血浆TM、t-PAIC及DD水平高于无AKI组,差异均有统计学意义(P<0.05)。逐步回归分析结果显示,红细胞输注次数增多(OR=1.763,95%CI:1.116~2.785)、血浆TM水平升高(OR=2.083,95%CI:1.358~3.196)、血浆t-PAIC水平升高(OR=1.684,95%CI:1.119~2.535)、血浆DD水平升高(OR=2.236,95%CI:1.458~3.429)均是影响AML患者红细胞输注期间发生AKI的危险因素(P<0.05)。ROC曲线分析结果显示,血浆TM、t-PAIC、DD三者联合检测对AML患者红细胞输注期间AKI发生风险的预测效能均高于3种指标单独检测(P<0.001)。结论 血浆TM、t-PAIC及DD水平升高均是AML患者红细胞输注期间发生AKI的独立危险因素,临床治疗前可通过检测血浆TM、t-PAIC和DD水平,根据检测结果采取预防措施,以降低早期AKI的发生风险。
Objective To explore the predictive value of plasma thrombomodulin(TM),tissuetype plasminogen activator-plasminogen activator inhibitor complex(t-PAIC),and D-dimer(DD)for the risk of acute kidney injury(AKI)during red blood cell(RBC)transfusion in patients with acute myeloid leukemia(AML),with a view to informing early intervention and individualized transfusion strategies.Methods From July 2023 to June 2024,105 AML patients undergoing RBC transfusion at Yan′an People′s Hospital were enrolled as the observation group,alongside 100 healthy individuals undergoing routine examination as controls.AML patients were allocated to those who developed AKI(n=26)and those who did not(n=79).Plasma TM,t-PAIC,and DD levels were measured and compared between groups.Baseline clinical data were compared,and stepwise logistic regression was adopted to identify factors associated with AKI during transfusion.Receiver operating characteristic(ROC)curves were constructed to assess the predictive performance of TM,t-PAIC,and DD.Results Compared with the control group,plasma TM,t-PAIC and DD in the observation group were significantly increased(P<0.05).The AKI incidence during transfusion among AML patients was 24.76%(26/105).There were no significant differences between AKI and nonAKI groups in sex distribution,age,red or white blood cell counts,coagulation times,hemoglobin,fibrinogen,blood urea nitrogen,serum creatinine,orβ2microglobulin(P>0.05).However,the AKI group received more transfusion episodes,had a higher proportion receiving≥10 U of RBCs,higher plasma TM and t-PAIC and DD leves,compared with the nonAKI group(P<0.05).Stepwise regression analysis demonstrated that increased transfusion episodes(OR=1.763;95%CI:1.116-2.785),elevated TM(OR=2.083;95%CI:1.358-3.196),elevated t-PAIC(OR=1.684;95%CI:1.119-2.535),elevated DD(OR=2.236;95%CI:1.458-3.429)were risk factors for AKI occurrence of AML patients receiving RBC transfusion(P<0.05).ROC analysis indicated that combined measurement of TM,t-PAIC,and DD predicted AKI risk better than any single marker for AML patients during RBC transfusion(P<0.001).Conclusion Elevated plasma TM,t-PAIC and DD levels are independent risk factors of AKI during RBC transfusion in AML patients.Detection of these markers before clinical treatment can guide preventive measures to reduce early AKI risk.
作者
冯妮娜
杨勤秦
李倩
张瑞
屈文静
赵苗苗
张莉
Feng Nina;Yang Qinqin;Li Qian;Zhang Rui;Qu Wenjing;Zhao Miaomiao;Zhang Li(Department of Transfusion Medicine,Yan′an People′s Hospital,Yan′an Shaanxi 716000,China;Department of Laboratory Medicine,Yan′an University Affiliated Hospital,Yan′an Shaanxi 716000,China;Department of Emergency,Yan′an People′s Hospital,Yan′an Shaanxi 716000,China)
出处
《保健医学研究与实践》
2025年第4期94-100,共7页
Health Medicine Research and Practice
基金
陕西省科协青年人才托举计划项目(20200305)。
