血小板计数、乳酸脱氢酶及可溶性白细胞介素-2受体水平评估恶性淋巴瘤患者骨髓浸润的临床价值

Clinical values of platelet count and levels of lactate dehydrogenase and soluble interleukin-2 receptor for assessing bone marrow infiltration in patients with malignant lymphoma

摘要:

目的 探讨影响恶性淋巴瘤患者骨髓浸润（BMI）的危险因素，评估血小板计数（PLT）、乳酸脱氢酶（LDH）及可溶性白细胞介素-2受体（sIL-2R）水平对BMI的预测价值。方法 选取2018年6月-2022年6月河北省人民医院收治的98例恶性淋巴瘤患者，根据是否发生BMI分为BMI组（22例）、非BMI组（76例）。采用单因素及多因素Logistic逐步回归分析患者发生BMI的危险因素，通过绘制受试者工作特征（ROC）曲线评估PLT、LDH及sIL-2R水平对恶性淋巴瘤患者BMI的预测效能。结果 单因素及多因素Logistic逐步回归分析结果显示，PLT升高［O^R=0.980（95% CI：0.964，0.996）］是恶性淋巴瘤患者发生BMI的保护因素（P <0.05），高龄［O^R=1.155（95% CI：1.046，1.276）］、临床分期（Ⅲ、Ⅳ期） ［O^R=5.829（95% CI：1.939，17.522）］、LDH升高［O^R=1.022（95% CI：1.009，1.035）］、sIL-2R升高［O^R=1.001（95% CI：1.000，1.002）］是恶性淋巴瘤患者发生BMI的危险因素（P <0.05）。ROC分析结果显示，当PLT ≤ 186.565×10⁹/L时，预测恶性淋巴瘤患者BMI的曲线下面积（AUC）为0.683，敏感性为77.3%（95% CI：0.579，0.843），特异性为64.5%（95% CI：0.536，0.809）；当LDH ≥ 263.875 u/L时，AUC为0.754，敏感性为68.2%（95% CI：0.535，0.809），特异性为80.3%（95% CI：0.646，0.890）；当sIL-2R ≥ 2554.500 u/mL时，AUC为0.670，敏感性为63.6%（95% CI：0.473，0.757），特异性为63.2%（95% CI：0.494，0.774）；3者联合预测的AUC为0.824，敏感性为81.8%（95% CI：0.692，0.920），特异性为81.6%（95% CI：0.669，0.906）。结论 PLT降低、LDH和sIL-2R升高是恶性淋巴瘤患者发生BMI的独立影响因素，可将其用于恶性淋巴瘤患者发生BMI的辅助预测手段，且3者联合可进一步提升预测效能。

Abstract:

Objective To investigate the risk factors for bone marrow infiltration (BMI) in patients with malignant lymphoma, and to investigate the predictive values of platelet count (PLT) and levels of lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) for the occurrence of BMI.Methods Ninety-eight patients with malignant lymphoma were divided into BMI group (n = 22) and non-BMI group (n = 76) according to whether they had BMI. Univariable and multivariable Logistic regression models were used to analyze the risk factors for BMI in patients with malignant lymphoma. The predictive efficacy of PLT and the levels of LDH and sIL-2R for BMI in patients with malignant lymphoma was assessed via the receiver operating characteristic (ROC) curves.Results The results of univariable and multivariable Logistic regression analyses showed that increased PLT [O^R = 0.980 (95% CI: 0.964, 0.996) ] was the protective factor for BMI in patients with malignant lymphoma (P < 0.05), and that advanced age [O^R = 1.155 (95% CI: 1.046, 1.276) ] and clinical stage (stage Ⅲ and Ⅳ) [O^R = 5.829 (95% CI: 1.939, 17.522) ], and high serum levels of LDH [O^R = 1.022 (95% CI: 1.009, 1.035) ] and sIL-2R [O^R = 1.001 (95% CI: 1.000, 1.002) ] were the risk factors for BMI in patients with malignant lymphoma (P < 0.05). The ROC curve analysis revealed that the area under the ROC curve (AUC) of PLT for predicting BMI in malignant lymphoma patients was 0.683 when PLT was not higher than 186.565 × 10⁹/L, with a sensitivity of 77.3% (95% CI: 0.579, 0.843), and a specificity of 64.5% (95% CI: 0.536, 0.809). The AUC of LDH for predicting BMI in malignant lymphoma patients was 0.754 when the level of LDH was not lower than 263.875 u/L, with a sensitivity of 68.2% (95% CI: 0.535, 0.809), and a specificity of 80.3% (95% CI: 0.646, 0.890). The AUC of sIL-2R for predicting BMI in malignant lymphoma patients was 0.670 when the level of sIL-2R was not lower than 2 554.500 u/mL, with a sensitivity of 63.6% (95% CI: 0.473, 0.757) and a specificity of 63.2% (95% CI: 0.494, 0.774). In addition, the AUC of the combined detection of the three for predicting BMI in malignant lymphoma patients was 0.824, with the sensitivity and the specificity being 81.8% (95% CI: 0.692, 0.920) and 81.6% (95% CI: 0.669, 0.906), respectively.Conclusions The decrease of PLT and the increases of serum LDH and sIL-2R levels are independent factors affecting and can be established as an auxiliary approach to predicting the occurrence of BMI in patients with malignant lymphoma, where the combination of the three indicators may further enhance the predictive efficacy.