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目的应用临床常规指标建立急性髓系白血病(acute myelocytic leukemia,AML)死亡风险模型,为AML患者预后判断提供参考。方法回顾性分析165例AML患者的临床资料,以5a生存情况为结果变量,对可能影响预后的因素进行Cox比例风险回归分析,建立死亡风险模型。结果单变量Cox比例风险回归显示,年龄>60岁、体能状态评分高、确诊时外周血白细胞计数>50×109/L、放弃治疗、诱导治疗(柔红霉素+阿糖胞苷方案)4周失败及姑息治疗增加5a死亡风险,确诊时血红蛋白>80g/L是预后的保护因素;多因素Cox比例风险回归显示,年龄(RR=1.872)、体能状态评分(RR=1.269)、确诊时血红蛋白(RR=0.585)、外周血白细胞计数(RR=1.838)和治疗方案(RR=1.651)是影响预后的独立因素,死亡风险模型:h(t,X)/h0(t)=Exp(0.627年龄+0.238体能状态评分-0.536血红蛋白+0.609白细胞计数+0.501治疗方案);此模型预测死亡的AUC为0.867,大于年龄(0.725)、血红蛋白(0.698)、体能状态评分(0.682)、白细胞计数(0.634)和治疗方案(0.587)。结论以年龄、血红蛋白、体能状态评分、白细胞计数和治疗方案建立的死亡风险模型可为AML预后提供中等强度的诊断能力。
Objective To establish a risk model of death of acute myelocytic leukemia (AML) by clinical routine and to provide a reference for the prognosis judgment of AML patients. Methods The clinical data of 165 patients with AML were retrospectively analyzed. Cox proportional hazards regression analysis was used to analyze the factors that may influence the prognosis of patients with 5-year-old survival, and the risk model of death was established. Results The univariate Cox proportional hazards regression showed that the age> 60 years old, the physical status score was high, and the peripheral white blood cell count> 50 × 109 / L at the time of diagnosis, giving up treatment and inducing treatment (daunorubicin + cytarabine 4) Weeks of failure and palliative treatment increased the risk of death by 5%, and hemoglobin> 80g / L at the time of diagnosis was a protective factor in prognosis. Multivariate Cox proportional hazards regression showed that age (RR = 1.872), fitness status score (RR = 0.585), peripheral blood leukocyte count (RR = 1.838) and treatment regimen (RR = 1.651) were independent prognostic factors. The mortality risk model was as follows: +0.238 fitness score -0.536 hemoglobin +0.609 white blood cell count +0.501 treatment plan). The AUC of predicted death was 0.867, higher than the age (0.725), hemoglobin (0.698), fitness status score (0.682), white blood cell count (0.634) And treatment (0.587). Conclusion The risk model of death established by age, hemoglobin, physical status score, white blood cell count and treatment regimen may provide moderate diagnostic power for prognosis of AML.