血清同型半胱氨酸、乳酸脱氢酶水平与小儿急性淋巴细胞白血病诱导化疗后复发风险的关系OA
The relationship between serum homocysteine,lactate dehydrogenase levels and the risk of recurrence in children with acute lymphoblastic leukemia after induction chemotherapy
目的 探究血清同型半胱氨酸(Hcy)、乳酸脱氢酶(LDH)与小儿急性淋巴细胞白血病(ALL)诱导化疗后复发的关系.方法 采用前瞻性队列研究,选择 2021 年 6 月至 2023 年 6 月河南省人民医院收治的 178 例ALL患儿作为研究对象,患儿均接受长春新碱+柔红霉素+门冬酰胺酶+泼尼松的诱导化疗方案,化疗 1 周期结束后检测患儿血清Hcy、LDH水平;以化疗后 2 年为随访观察期限,统计患儿复发情况,分析血清Hcy、LDH水平与ALL患儿诱导化疗后复发的关系,同时绘制受试者工作特征曲线(ROC),评估其预测价值.结果 178 例患儿剔除 12 例,最终纳入 166 例.随访 2 年,166 例ALL患儿复发占比 27.11%(45/166).复发组初诊危险程度(高危)、第 46 天微小残留病(MRD)(≥0.01%)占比、血清Hcy、LDH水平均高于未复发组,差异有统计学意义(P＜0.05);经Logistic回归分析检验显示血清Hcy、LDH是影响患儿复发的独立危险因素(P＜0.05);ROC曲线显示,血清Hcy、LDH水平单独预测ALL患儿诱导化疗后复发的AUC分别为 0.795、0.784,联合预测的AUC为 0.893,经DeLong检验显示联合预测价值显著高于单独Hcy、LDH的预测价值(P＜0.05).结论 血清Hcy、LDH水平与ALL患儿诱导化疗后复发有关,检测二者水平可预测ALL患儿诱导化疗后复发情况,且联合预测价值更高,值得临床应用.
Objective To Explore the relationship between serum homocysteine(Hcy),lactate dehydrogenase(LDH)and recurrence of acute lymphoblastic leukemia(ALL)after induction chemotherapy in children Methods Using a prospective cohort study,178 children with ALL who were admitted to Henan Provincial People's Hospital from June 2021 to June 2023 were selected as the study subjects.All patients received induction chemotherapy with vincristine,daunorubicin,asparaginase,and prednisone fter one cycle of chemotherapy,the serum Hcy and LDH levels of the children were measured;Taking 2 years after chemotherapy as the follow-up observation period,the recurrence status of the children was statistically analyzed,and the relationship between serum Hcy and LDH levels and the recurrence of ALL children after induction chemotherapy was analyzed In addition,receiver operating characteristic(ROC)curves were plotted to evaluate their predictive value.Results Of the 178 children,12 were excluded,and 166 were finally included.During the 2-year follow-up,the recurrence rate among the 166 children with ALL was 27.11%(45/166).The proportions of high-risk status at initial diagnosis and minimal residual disease(MRD)on day 46(≥0.01%),as well as the serum Hcy and LDH levels,were higher in the recurrence group than in the non-recurrence group,and the differences were statistically significant(P＜0.05).Logistic regression analysis showed that serum Hcy and LDH levels were independent risk factors for recurrence in these children(P＜0.05).ROC curve shows that serum Hcy and LDH levels alone predict the AUC of relapse in ALL patients after induction chemotherapy,which are 0.795 and 0.784,respectively,while the AUC of their combined prediction was 0.893.DeLong test showed that the predictive value of the combined model was significantly higher than that of Hcy or LDH alone(P＜0.05).Conclusion The levels of serum Hcy and LDH are related to the recurrence of ALL patients after induction chemotherapy.Detecting the levels of both can predict the recurrence of ALL patients after induction chemotherapy,and the combined prediction value is higher,which is worthy of clinical application.
赵梦萍;黄翠;李玉龙
河南省人民医院 血液病研究所,河南 郑州 450000河南省人民医院 血液病研究所,河南 郑州 450000河南省人民医院 血液病研究所,河南 郑州 450000
急性淋巴细胞白血病儿童诱导化疗复发同型半胱氨酸乳酸脱氢酶
acute lymphoblastic leukemiachildrenInduction chemotherapyrecurrencehomocysteinelactate dehydrogenase
《临床研究》 2026 (3)
1-5,5
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