[1]谢怡华,李 君,张晓磊,等.血液病患者血小板输注疗效预测模型的构建及评价[J].现代检验医学杂志,2025,40(05):101-106.[doi:10.3969/j.issn.1671-7414.2025.05.019]
　XIE Yihua,LI Jun,ZHANG Xiaolei,et al.Establishment and Evaluation of A Forecasting Model for Platelet Transfusion Efficacy in Patients with Hematological Disorders[J].Journal of Modern Laboratory Medicine,2025,40(05):101-106.[doi:10.3969/j.issn.1671-7414.2025.05.019]
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血液病患者血小板输注疗效预测模型的构建及评价()

《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年05期
页码:
101-106
栏目:
论著
出版日期:
2025-09-15

文章信息/Info

Title:
Establishment and Evaluation of A Forecasting Model for Platelet Transfusion Efficacy in Patients with Hematological Disorders
文章编号:
1671-7414（2025）05-101-06
作者:
谢怡华1，李 君1，张晓磊1，崔 妍1，王 澜1，张 鹏1，鲁弼嘉1，商宇麒1，陈子奇1，李浩然1，郑款云2
1.开滦总医院输血科，河北唐山 063001;2.唐山市工人医院检验科，河北唐山 063099
Author(s):
XIE Yihua1，LI Jun1，ZHANG Xiaolei1，CUI Yan1，WANG Lan1，ZHANG Peng1，LU Bijia1，SHANG Yuqi1，CHEN Ziqi1，LI Haoran1，ZHENG Kuanyun2
1.Department of Blood Transfusion Branch, Kailuan General Hospital, Hebei Tangshan 063001, China;2.Department of Clinical Laboratory, Tangshan Workers Hospital, Hebei Tangshan 063099, China
关键词:
血液系统疾病; 血小板输注无效; 预测模型; 应用效果
分类号:
R55；R457.1
DOI:
10.3969/j.issn.1671-7414.2025.05.019
文献标志码:
A
摘要:
目的?构建血液病患者血小板输注疗效预测模型，应用受试者工作特征（ROC）曲线和临床病例评价预测模型的应用效果。方法选取2020年1月~2023年12月在开滦总医院接受血小板输注治疗的485例血液病患者,利用校正血小板计数增加值（CCI）将患者分为血小板输注有效组（n=340）和输注无效组（n=145）。利用多因素Logistic回归分析建立血小板输注疗效预测模型，应用（ROC）曲线评价预测模型的应用效果。利用109例临床病例验证模型实际应用效果，计算灵敏度、特异度和准确度。结果485例血液病患者血小板输注无效发生率为29.90%（145/485）；与有效组比较，无效组既往血小板输注次数多，差异具有统计学意义（t=-4.435，P＜0.05）；无效组脾亢增多，再生障碍性贫血、淋巴瘤明显高于其他诊断，发生感染率高，血小板抗体阳性率高，差异具有统计学意义（χ2=6.301～37.522，均P＜0.05）。多因素Logistic回归分析发现既往血小板输注次数、合并感染、白血病、再生障碍性贫血和血小板抗体是血液病患者血小板输注无效的危险因素（waldχ2=5.224～21.548，均P＜0.05）。基于这些危险因素构建血小板输注效果预测模型1，2。ROC曲线评价预测模型应用效果，预测模型1的曲线下面积（AUC）、截点、对应的敏感度和特异度分别是：0.884，0.042，82.35%，88.89%；预测模型2的AUC，截点、对应的敏感度和特异度分别是：0.910，59.784，81.18%，94.44%；预测模型1，2的Z值分别为12.159，13.151，预测模型2的预测效果优于预测模型1。实际应用结果显示，预测模型1，2的敏感度、特异度、准确度分别为85.71%，92.05%，90.89%和90.48%，93.18%，92.66%。结论血液病患者血小板输注无效率较高，血小板输注效果预测模型1，2预测血小板输注无效均有较好效果，且预测模型2更优于预测模型1，可为血液病患者精准输注血小板提供可靠的依据。
Abstract:
Objective To establish the therapeutic effect prediction model of platelet transfusion in hematological patients, and receiver operating characteristic (ROC) curve and clinical cases are used to evaluate the clinical application value of the predic-tion model. Methods A total of 485 patients with hematological diseases who received platelet transfusion therapy in Kailuan General Hospital from January 2020 to December 2023 were selected,corrected count increment (CCI) was used to divide the patients into platelet transfusion effective group (n=340) and transfusion ineffective group (n=145). Multivariate Logistic regres-sion analysis was used to establish the prediction model of platelet infusion efficacy, and ROC curve was used to evaluate the application effect of the forcasting model. 109 clinical cases were used to verify the practical application effect of the model, and the sensitivity, specificity and accuracy were calculated. Results Among 485 patients with hematological diseases, the incidence of ineffective platelet transfusion was 29.90% (145/485). Compated with the effective group, the ineffective group had more previous platelet transfusions was higher, and the difference was statistically significant (t=-4.435, P<0.05). In the ineffective group, there were more cases of hyperplenism, aplastic anemia and lymphoma, higher infection rate and higher positive rate of platelet antibody, and the differences were statistically significant (χ2=6.301～37.522, all P<0.05). Multivariate Logistic regres-sion analysis found that previous platelet infusion times, infection, leukemia , aplastic anemia and platelet antibodies were risk factors for ineffective platelet transfusion in patients with hematological diseases (Wald χ2=5.224～21.548, all P<0.05). Based on these risk factors, platelet infusion effect prediction models 1 and 2 were constructed.ROC curve was used to evaluate the application effect of the prediction model. The area under the curve (AUC), cut-off point, sensitivity and specificity of model 1 were 0.884, 0.042, 82.35%, 88.89%. The AUC, cut-off point, corresponding sensitivity and specificity of prediction model 2 were 0.910, 59.784, 81.18%, 94.44%, respectively.The Z values of model 1 and model 2 were 12.159 and 13.151, respectively. The prediction effect of model 2 was better than that of model 1.The actual application results showed that the sensitivity, specificity and accuracy of prediction model 1,2 were 85.71%, 92.05%, 90.89% and 90.48%, 93.18%, 92.66%, respectively. Conclusion The ineffective rate of platelet transfusion in hematological patients is relatively high. The prediction models 1 and 2 for platelet transfusion effectiveness have good results in predicting ineffective platelet transfusion, and prediction model 2 is better than pre-diction model 1, which can provide reliable basis for hematological patients on accurate platelet transfusion.

参考文献/References:

[1] 苏婷婷，任荣香，王承华，等．急性白血病血小板输注疗效影响因素及其对临床预后的影响研究[J]．齐齐哈尔医学院学报，2022，43（2）：116-120． SU T T, REN R X, WANG C H, et al. Study on the influ-encing factors of platelet transfusion efficacy and its effect on prognosis of patients with acute leukemia[J]. Journal of Qiqihar Medicine University, 2022, 43(2): 116-120.
[2] 任思婳，金晶纯，金丽，等．国内外血小板输注现状的分析[J]．临床输血与检验，2019，21（2）：217-221． REN S H, JIN J C, JIN L, et al. Analysis of current situation of platelet transfusion at home and abroad[J]. Journal of Clinical Transfusion and Laboratory Medi-cine, 2019, 21(2): 217-221.
[3] 潘锡龙，陈丽，梁利斯.基于Logistic回归和ROC曲线评价外周血PCT,CRP,NEU%和PLT水平在血流感染中的联合预测价值[J].现代检验医学杂志, 2020, 35（6）:119-124.PAN X L, CHEN L, LIANG L S. Evaluation of the combined predictive value of peripheral blood PCT, CRP, NEU% and PLT levels in bloodstream infection based on Logistic regression and ROC curve[J]. Journal of Modern Laboratory Medicine, 2020, 35(6): 119-124.
[4] 陈雪飞.单采血小板输注疗效影响因素分析及预测模型构建[J].蚌埠医学院学报,2022,47（8）:1074-1077. CHEN X F. Analysis of the influencing factors of apheresis platelet transfusion efficacy and construction of prediction model[J]. Journal of Bengbu Medical Col-lege, 2022, 47(8): 1074-1077.
[5] 黎敏，姜伟，杜慧，等．单采血小板输注疗效列线图预测模型的构建与评估[J]．中国输血杂志，2021， 34（6）：613-616． LI M, JIANG W, DU H, et al. Construction and evalu-ation of a nomogram prediction model for the efficacy of apheresis platelet transfusion[J]. Chinese Journal of Blood Transfusion, 2021, 34(6): 613-616.
[6] 李彬钰，马锡慧，李蕊，等．老年新型冠状病毒感染患者外周血淋巴细胞亚群和多种细胞因子水平分析及其临床价值研究[J]．现代检验医学杂志，2024， 39（2）：113-118, 162． LI B Y, MA X H, LI R, et al. Analysis and clinical value of lymphocyte subsets and various cytokines of peripheral blood in elderly patients with COVID-19[J]. Journal of Modern Laboratory Medicine, 2024, 39(2): 113-118, 162.
[7] 游时松，卢黎琦，蔡群，等.310名血液病患者单采血小板输注效果分析[J].中国输血杂志,2023,36（1）:36-41. YOU S S, LU L Q, CAI Q, et al. Efficacy of apheresis platelet transfusion in 310 patients with haematological diseases[J]. Chi-nese Journal of Blood Transfusion, 2023, 36(1): 36-41.
[8] 杨小莉．血小板输注无效原因及对策研究进展[J]．检验医学与临床，2019，16（7）：985-988． YANG X L. Research progress on causes and counter-measures of ineffective platelet transfusion[J]. Labora-tory Medicine and Clinic, 2019, 16(7): 985-988.
[9] 中国输血协会人类组织抗原专业委员会，中国输血协会免疫血液学专业委员会.免疫性血小板输注无效的判定及临床实践专家共识[J]．临床输血与检验， 2022，24（3）：273-278． Working Party on Histocompatibility, Chinese Society of Blood Transfusion, Working Party on Immunohema-tology, Chinese Society of Blood Transf-usion(CSBT). Expert consensus for determinant principle and clinical practice of immunmediated platelet transfusion refrac-toriness [J]. Journal of Clinical Transfusion and Labo-ratory Medicine, 2022, 24(3): 273-278.
[10] 王帅，李君．肝硬化患者ABO和Rh(D)同型随机配合性输血Rh(CcEe)同种免疫及影响因素分析[J]．临床输血与检验，2022，24（4）：443-447． WANG S, LI J. Analyze the influencing factors and alloimmunization on Rh(CcEe)in patients with liver cirrhosis after ABO, Rh(D) isotype random matched blood transfusion[J]. Journal of Clinical Transfusion and Laboratory Medicine, 2022, 24(4): 443-447.
[11] 李君，曹立瀛，侯金友，等.非手术患者红细胞输注疗效预测模型研究[J].临床输血与检验，2020，22（1）：18-22． LI J, CAO L Y, HOU J Y, et al. Predictive modeling of erythrocyte transfusion efficacy in non-surgical pa-tients[J]. Journal of Clinical Transfusion and Laborato-ry Medicine, 2020, 22(1): 18-22.
[12] 江灵，王洁，王雨涵，等．血小板抗体检测及交叉配型在血小板输注患者中的运用[J]．中国输血杂志， 2019，32（3）：263-266． JIANG L, WANG J, WANG Y H, et al. Utilization of platelet antibody detection and cross matching for hemato-logic patients undergoing platelet transfusion[J]. Chinese Journal of Blood Transfusion, 2019, 32(3): 263-266.
[13] 张敏敏，肖翡，李娟，等．血小板输注疗效影响因素探究及其与预后的关系[J]．暨南大学学报(自然科学与医学版)，2020，41（4）：351-357． ZHANG M M, XIAO F, LI J, et al. Study on the factors af-fecting the therapeutic effect of platelet transfusion and its re-lation with prognosis[J]. Journal of Jinan University(Natural Science & Medicine Edition), 2020, 41(4): 351-357.
[14] 杜旭利，白艳丽，邓苗苗，等.血小板抗体阳性及输血次数对血液肿瘤患者单采血小板输血效果的影响研究[J].现代医药卫生，2023，39（22）：3821-3824． DU X L, BAI Y L, DENG M M, et al. Study on the influ-ence of platelet antibody positive and blood transfusion times on the effect of single platelet collection and trans-fusion in patients with hematological tumors[J]. Journal of Modern Medicine & Health, 2023, 39(22): 3821-3824.
[15] SONG X F, QI J Q, FANG K, et al. A meta-analysis of risk factors associated with platelet transfusion refractoriness[J]. International Journal of Hematology, 2023, 117(6): 863-875.
[16] CHEN X Y, ZHAO Y H, L? Y, et al. Immunological platelet transfusion refractoriness:current insights from mechanisms to therapeutics[J]. Platelets, 2024, 35(1): 2306983.
[17] 张桂芬，闫萌．反复输血后血小板输注无效患者抗体阳性率、特异性及影响因素分析[J]．临床血液学杂志(输血与检验)，2020，33（6）：391-393． ZHANG G F, YAN M. Analysis of positive rate, specificity and influencing factors of PLT antibody detection in patients with ineffective platelet transfusion after repeated transfu-sion[J]. Journal of Clinical Hematology (Blood Transfusion& Laboratory Medicine), 2020, 33(6): 391-393.
[18] BELIZAIRE R, MAKAR R S. Non-alloimmune mechanisms of thrombocytopenia and refractoriness to platelet transfu-sion[J]. Transfusion Medicine Reviews, 2020, 34(4): 242-249.

备注/Memo

备注/Memo:
基金项目：河北省2023年度医学科学研究课题计划（No.20231864）。
作者简介：谢怡华（1983-），女，硕士，主治医师，研究方向：临床输血学，E-mail：446900677@qq.com。
通讯作者：李君（1985-），女，硕士，副主任技师，研究方向：输血前免疫血液学试验研究，E-mail：278800026@qq.com。
更新日期/Last Update: 2025-09-15