三氧化二砷治疗急性早幼粒细胞白血病早期死亡风险预测模型构建及验证OA
Construction and Validation of a Risk Prediction Model for Early Death in Acute Promyelocytic Leukemia Treated with Arsenic Trioxide
目的 分析三氧化二砷(As2O3)治疗急性早幼粒细胞白血病(APL)早期死亡的危险因素并构建风险预测模型.方法 收集 2020年2 月至 2023 年 11 月医院收治的接受As2O3 治疗的 340 例APL患者的临床资料,按 7∶3 的比例随机分为训练集(238 例)和验证集(102 例),根据患者入院后 30d内的存活情况,将训练集分为生存组和死亡组.采用多因素Logistic回归模型分析训练集中As2O3 治疗APL早期死亡的危险因素,以此构建风险预测模型并验证.结果 340 例患者中死亡 61 例(17.94%).训练集中危险因素分析显示,年龄>60 岁、合并感染、融合基因S(+)型、危险分层为高危、并发弥散性血管内凝血(DIC)、白细胞计数(WBC)>10×109/L、单核细胞趋化蛋白-1(MCP-1)水平升高是As2O3 治疗APL早期死亡的独立危险因素(P<0.05).基于此构建风险预测模型,受试者工作特征(ROC)曲线分析显示,训练集和验证集的曲线下面积(AUC)分别为 0.871[95%CI(0.812,0.915)]和 0.842[95%CI(0.797,0.892)];Hosmer-Lemeshow检验结果分别为x2=0.619(P=0.510)和x2=0.641(P=0.482);决策曲线分析(DCA)结果显示,该模型在预测患者早期死亡风险时具有良好的临床实用性.结论 年龄>60岁、合并感染、融合基因S(+)型、并发DIC、WBC>10×109/L、MCP-1 水平升高均为三As2O3 治疗APL早期死亡的危险因素,基于此建立的风险预测模型有助于帮助临床评估高风险患者,减少早期死亡的发生.
Objective To analyze the risk factors for early death in acute promyelocytic leukemia(APL)treated with arsenic trioxide(As2O3)and to construct a risk prediction model.Methods The clinical data of 340 APL patients treated with As2O3 in hospital from February 2020 to November 2023 were collected.The patients were randomly divided into the training set(238 cases)and the validation set(102 cases)at the ratio of 7∶3.According to their survival status within 30 d after admission,the training set was classified into the survival group and the death group.Multivariate Logistic regression analysis was used to identify risk factors for early death in the training set,based on which a risk prediction model was constructed and validated.Results Among the 340 patients,61 patients(17.94%)died.In the training set,multivariate analysis showed that age>60 years old,complicated infection,fusion gene S(+)type,high-risk stratification,complicated disseminated intravascular coagulation(DIC),white blood cell count(WBC)>10×109/L,and elevated monocyte chemoattractant protein-1(MCP-1)level were independent risk factors for early death in APL treated with arsenic trioxide(P<0.05).The risk prediction model was constructed based on these factors.Receiver operating characteristic(ROC)curve analysis was performed,and the area under the curve(AUC)was 0.871[95%CI(0.812,0.915)]for the training set and 0.842[95%CI(0.797,0.892)]for the validation set.The Hosmer-Lemeshow test was conducted,and the results were x2=0.619(P=0.510)for the training set and x2=0.641(P=0.482)for the validation set.Decision curve analysis(DCA)was performed,and the model was shown to have good clinical utility in predicting the risk of early death in patients.Conclusion Age>60 years,complicated infection,fusion gene S(+)type,complicated DIC,WBC>10×109/L,and elevated MCP-1 level are risk factors for early death in APL patients treated with arsenic trioxide.The established risk prediction model is helpful for clinicians to assess high-risk patients and reduce the occurrence of early death.
王笺
四川省乐山市中医医院,四川 乐山 614000
医药卫生
三氧化二砷急性早幼粒细胞白血病危险因素预测模型
arsenic trioxideacute promyelocytic leukemiarisk factorsprediction model
《中国药业》 2026 (12)
109-113,5
四川省医学(青年创新)科研课题[Q20215].
评论