白蛋白预测初诊非M3型急性髓细胞白血病患者预后的研究

丁亚群; 黄祥涛; 孙燕泥; 万佳; 武贵仙; 徐双年

doi:10.16016/j.2097-0927.202304067

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白蛋白预测初诊非M3型急性髓细胞白血病患者预后的研究

临床医学 | 更新时间：2026-01-09

- 白蛋白预测初诊非M3型急性髓细胞白血病患者预后的研究
- Prognostic value of albumin in patients with de novo non-M3 acute myeloid leukemia
- 陆军军医大学学报 2023年45卷第20期页码：2106-2112
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院血液病中心
- 作者简介：
  
  [徐双年，E-mail: xushuangnian@tmmu.edu.cn XU Shuangnian, E-mail: xushuangnian@tmmu.edu.cn
- 基金信息：
  
  国家自然科学基金面上项目(82370174);‍国家自然科学基金青年科学基金(82000169);重庆市自然科学基金(cstc2020jcyj-msxmX1058);重庆市科卫联合项目(2018QNXM045)
- DOI：10.16016/j.2097-0927.202304067
  中图分类号： R446.112;R730.7;R733.71
- 收稿：2023-04-14，
  
  修回：2023-06-14，
  
  纸质出版：2023-10-30
- 稿件说明：
移动端阅览
丁亚群, 黄祥涛, 孙燕泥, 等. 白蛋白预测初诊非M3型急性髓细胞白血病患者预后的研究[J]. 陆军军医大学学报, 2023,45(20):2106-2112.

Yaqun DING, Xiangtao HUANG, Yanni SUN, et al. Prognostic value of albumin in patients with de novo non-M3 acute myeloid leukemia[J]. Journal of Army Medical University, 2023, 45(20): 2106-2112.
丁亚群, 黄祥涛, 孙燕泥, 等. 白蛋白预测初诊非M3型急性髓细胞白血病患者预后的研究[J]. 陆军军医大学学报, 2023,45(20):2106-2112. DOI： 10.16016/j.2097-0927.202304067.

Yaqun DING, Xiangtao HUANG, Yanni SUN, et al. Prognostic value of albumin in patients with de novo non-M3 acute myeloid leukemia[J]. Journal of Army Medical University, 2023, 45(20): 2106-2112. DOI： 10.16016/j.2097-0927.202304067.

摘要

目的

探讨入院首次血清白蛋白(albumin，ALB)水平在初诊非M3型急性髓细胞白血病(acute myeloid leukemia，AML)患者中的预后价值。

方法

采用回顾性队列研究设计，收集2012年1月至2019年7月本中心收治的初诊非M3型AML患者的住院病历资料。根据X-Tile软件产生的最佳截断值30.4 g/L将患者分为正常ALB组(

=196)和低ALB组(

=52)，比较两组患者临床资料的组间差异如性别、年龄、外周白细胞(white blood cell，WBC)计数、血红蛋白(hemoglobin，HB)、血小板(platelet，PLT)计数、乳酸脱氢酶(lactate dehydrogenase，LDH)、法美英协作组(French-American-British，FAB)分型、骨髓原始细胞比例(bone marrow blasts

BM blasts)、欧洲白血病网络(European leukemia network，ELN)危险度分层以及治疗情况等，随访所有患者的生存状况。通过Kaplan-Meier曲线和Cox回归模型比较两组间生存差异。构建基于Cox多因素回归分析结果的预测模型，采用校准曲线分析、受试者工作特征(receiver operating characteristic，ROC)曲线对模型进行评价，并通过一致性指数(C-index)及决策

曲线分析(decision curve analysis，DCA)评价ALB对模型的预测增量值。

结果

与正常ALB组相比，低ALB组患者诱导化疗后的完全缓解(complete responce，CR)率更低(28.8%

62.8%，

0.001)，病死率更高(63.4%

30.6%，

0.001)。生存分析显示，低ALB组总生存时间(overall survival，OS)和无病生存时间(disease-free survival，DFS)均低于正常ALB组(

0.001)。多因素分析表明ALB为AML预后OS的独立预测因子(

=4.352，95%

：2.760~6.863，

0.001)。基于Cox分析结果构建的模型预测1、3年生存率的AUC值分别为0.800 (95%

：0.734~0.867)、0.890 (95%

：0.795~0.984)，校准曲线显示列线图预测的生存率与实际生存率相近。相较于传统危险分层及未纳入ALB的模型，纳入ALB后模型C-指数更高(0.564

0.671

0.730)，DCA显示其临床获益也更高。

结论

ALB是AML患者的独立预后因素，纳入该指标可显著提高预后模型的临床预测能力和随之带来的临床收益。

Abstract

Objective

To explore the prognostic value of serum albumin (ALB) level at admission in

de novo

non-M3 acute myeloid leukemia (AML).

Methods

A retrospective cohort study was conducted on the medical records of newly diagnosed non-M3 AML patients admitted to our center from January 2012 to July 2019. They were divided into a normal ALB group (

=196) and a low ALB group (

=52) based on the optimal cut-off value of 30.4 g/L generated by the X-Tile software. The clinical data were compared between the 2 groups

such as gender

age

white blood cell (WBC) count

hemoglobin (HB) level

platelet (PLT) count

lactate dehydrogenase (LDH) level

French American British (FAB) type

percentage of bone marrow blasts (BM blasts)

risk stratification of the European Leukemia Network (ELN)

and treatment regimens. All patients were followed up for their survival status. Kaplan-Meier survival curve and Cox regression model were used to compare the survival between the 2 groups. A prediction model was constructed based on t

he results of multivariate Cox regression analysis. Calibration curve and receiver operating characteristic (ROC) curve were plotted to evaluate the model

and Harrell's concordance index (C-index) and decision curve analysis (DCA) were performed to evaluate the incremental value of ALB's prediction model.

Results

The low ALB group had a significantly lower complete response (CR) rate after induction chemotherapy (28.8%

62.8%

0.001) and a higher mortality rate (63.4%

30.6%

0.001) than the normal ALB group. Survival analysis found that the overall survival time (OS) and disease-free survival time (DFS) were significantly shorter in the low ALB group than the normal ALB group (

0.001). Multivariate analysis showed that ALB was an independent predictor of OS in AML prognosis (

=4.352

95%

: 2.760~6.863

0.001). The AUC value of the model constructed based on Cox analysis results was 0.800 (95%

: 0.734~0.867) and 0.890 (95%

: 0.795~0.984)

respectively

for predicting 1-year and 3-year survival rate. The calibration curve performed well between predicted survival and actual survival. Compared with traditional risk stratification and the model without ALB factor

our model that included ALB had a higher C-index (0.564

0.671

0.730). DCA also showed its higher clinical benefits.

Conclusion

ALB is an independent predictor of prognosis in non-M3 AML patients

which can significantly improve the clinical predictive ability and the attendant benefits of survival prediction models.

关键词

Keywords

references

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