LDL⁃C/HDL⁃C对慢性髓系白血病患者深度分子学反应的预测价值
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国家自然科学基金(81870119,82170153)


Predictive value of LDL⁃C/HDL⁃C for deep molecular response in patients with chronic myeloid leukemia in chronic phase
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    摘要:

    目的:探讨血脂水平对慢性髓系白血病慢性期(chronic myeloid leukemia-chronic phase,CML-CP)患者治疗反应的预测价值。方法:回顾性分析453例CML-CP患者的临床资料。采用全自动生化分析仪检测患者在初诊时及不同缓解阶段的血脂水平,应用Logistic回归模型进行预后相关因素分析。结果:CML患者与正常人相比表现为总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)水平低,甘油三酯(triglyceride,TG)、TC/HDL-C、non-HDL-C/HDL-C和TG/HDL-C水平高(P < 0.001),LDL-C/HDL-C无明显差异(P > 0.05),且不同年龄段血脂谱改变与总体趋势一致,绝经期后患者表现为TG和LDL-C水平高。CML患者达到主要分子学反应(major molecular response,MMR)及深度分子学反应(deep molecular response,DMR)时血脂水平相较于初诊时明显恢复。与MMR患者相比,DMR患者表现为更低水平的LDL-C、TC/HDL-C、LDL-C/HDL-C和non-HDL-C/HDL-C(P < 0.05)。多因素Logistic回归分析表明LDL-C/HDL-C(OR=0.511,95%CI:0.330~0.793,P=0.003)、Sokal评分(P=0.016)和酪氨酸激酶抑制剂(tyrosine kinase inhibitor,TKI)治疗时间(OR=1.025,95%CI:1.013~1.037,P < 0.001)与DMR显著相关。结论:初诊CML患者血脂代谢紊乱,TKI有效逆转血脂谱。血脂水平监测对于CML患者疗效评估具有重要意义,且LDL-C/HDL-C可作为MMR患者预测DMR的独立指标。

    Abstract:

    Objective:To investigate the predictive value of lipid levels on response to therapy in patients with chronic myeloid leukemia in chronic phase(CML-CP). Methods:The clinical data of 453 patients with CML-CP were retrospectively analyzed. Serum lipid levels were compared between groups. Logistic regression models were applied to analyze prognostic-related factors. Results: Patients with CML showed low total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C) levels and high triglyceride(TG),TC/HDL-C,non-HDL-C/HDL-C,and TG/HDL-C levels compared with normal controls(P < 0.001),and no significant difference in LDL-C/HDL-C(P > 0.05). The changes of blood lipid profiles in different age groups were consistent with the overall trend,and post-menopausal patients showed high levels of TG and LDL-C. Lipid levels recovered significantly at the time of achieving major molecular response(MMR) and deep molecular response(DMR) compared to the initial diagnosis. Patients with DMR showed lower LDL-C,TC/HDL-C,LDL-C/HDL-C,and non-HDL-C/HDL-C compared to patients with MMR(P < 0.05). Multivariate logistic regression analysis showed that LDL-C/HDL-C(OR=0.511,95%CI:0.330~0.793,P=0.003),Sokal risk score(P=0.016) and duration of TKI treatment(OR=1.025,95%CI:1.013~1.037,P < 0.001) were significantly associated with the achievement of DMR. Conclusion:Lipid metabolism is disturbed in patients with newly diagnosed CML and TKI is effective in reversing the lipid profile. Lipid level monitoring is important for efficacy assessment in CML patients and LDL-C/HDL-C can be used as an independent predictor of DMR.

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徐子瑶,胡金花,孙 倩,刘文洁,洪 鸣,钱思轩. LDL⁃C/HDL⁃C对慢性髓系白血病患者深度分子学反应的预测价值[J].南京医科大学学报(自然科学版),2022,42(4):503-510

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  • 收稿日期:2021-08-26
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  • 在线发布日期: 2022-04-25
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