成人原发免疫性血小板减少症患者血清sTLT1、sHLA-G、IFN-γ水平及对患者预后不良的预测价值OA

Objective To investigate the predictive value of serum soluble human leukocyte antigen-G(sHLA-G),interferon-γ(IFN-γ)and soluble triggering receptor expressed on myeloid cells like transcript 1(sTLT1)levels for poor prognosis in adult patients with primary immune thrombocytopenia(ITP).Methods A total of 164 ITP patients admitted to the hospital from July 2022 to July 2024 were selected as the ITP group.According to the severity of the disease,they were divided into mild group,moderate group and severe group,and according to the prognosis,they were divided into good prognosis group and poor prognosis group.In addition,170 healthy people who underwent physical examination in the hospital during the same pe-riod were selected as the control group.Baseline data of all subjects were collected.Enzyme-linked immunosor-bent assay was used to detect the serum levels of sHLA-G,IFN-γ and sTLT1 in all subjects.The serum levels of sHLA-G,IFN-γ and sTLT1 in ITP patients with different conditions and prognosis were compared.Multi-variate Logistic regression was used to analyze the influencing factors of poor prognosis in ITP patients.Re-ceiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum sHLA-G,IFN-γ and sTLT1 levels alone and in combination for poor prognosis of ITP patients.The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the prediction model.Results The serum levels of sHLA-G,IFN-γ and sTLT1 in ITP group were significantly higher than those in control group(P<0.05).There were 38 cases in the mild group,65 cases in the moderate group and 61 cases in the severe group.The serum levels of sHLA-G,IFN-γ and sTLT1 in the severe group were higher than those in the moderate and mild groups,and the serum levels of sHLA-G,IFN-γ and sTLT1 in the moderate group were higher than those in the mild group,and the differences were statistically significant(P<0.05).There were 42 cases in the poor prognosis group and 122 cases in the good prognosis group.The serum levels of sHLA-G,IFN-γ and sTLT1 in the poor prognosis group were higher than those in the good prognosis group,and the differences were statistically sig-nificant(P<0.05).Multivariate Logistic regression analysis showed that elevated serum sHLA-G,IFN-γ and sTLT1 levels were risk factors for poor prognosis in ITP patients(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum sHLA-G,IFN-γ and sTLT1 for predicting poor prognosis of ITP patients were 0.807,0.789 and 0.838 respectively.All were lower than the AUC of the combined detection of the three markers in predicting poor prognosis of ITP patients(Z=3.148,3.313,2.300,P<0.05).Hosmer-Lemeshow goodness of fit test showed χ2=5.026,P=0.755,suggesting that the calibration curve was in good agreement with the ideal curve.Conclusion The serum levels of sHLA-G,IFN-γ and sTLT1 were increased in ITP patients,and the combined detection had a high predictive value for poor prognosis in ITP patients.