[1]刘静静,刘 娟,何佩东,等.骨髓增生异常综合征患者血浆TAT，PIC，TM和t-PAIC水平对总生存期和无白血病生存期的评价及预测价值[J].现代检验医学杂志,2025,40(03):139-144.[doi:10.3969/j.issn.1671-7414.2025.03.026]
　LIU Jingjing,LIU Juan,HE Peidong,et al.Evaluation and Predictive Value of Plasma TAT, PIC, TM and t-PAIC Levels in Patients with Myelodysplastic Syndrome for Overall Survival and Leukemia-free Survival[J].Journal of Modern Laboratory Medicine,2025,40(03):139-144.[doi:10.3969/j.issn.1671-7414.2025.03.026]
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骨髓增生异常综合征患者血浆TAT，PIC，TM和t-PAIC水平对总生存期和无白血病生存期的评价及预测价值()

《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年03期
页码:
139-144
栏目:
论著
出版日期:
2025-05-15

文章信息/Info

Title:
Evaluation and Predictive Value of Plasma TAT, PIC, TM and t-PAIC Levels in Patients with Myelodysplastic Syndrome for Overall Survival and Leukemia-free Survival
文章编号:
1671-7414（2025）03-139-06
作者:
刘静静1a，刘 娟1a，何佩东1a，李新红1a，刘素荣1a，朱 娇1a，权阳加1a，王春莹1b，胡颖辉2
（1.兵器工业五二一医院 a.肿瘤血液科；b.消化内科，西安 710065；2.西安交通大学第一附属医院干五涉外病房，西安 710061）
Author(s):
LIU Jingjing1a，LIU Juan1a，HE Peidong1a，LI Xinhong1a，LIU Surong1a，ZHU Jiao1a，QUAN Yangjia1a， WANG Chunying1b，HU Yinghui2
(1a. Department of Oncology and Hematology；1b. Department of Gastroenterology，521 Hospital of Ordnance Industry，Xi’an 710065, China；2．Department of Ganwu Foreign-related Ward，the First Affiliated Hospital of Xi’an Jiaotong University，Xi’an 710061，China)
关键词:
凝血酶-抗凝血酶Ⅲ复合物; 纤溶酶-α2-纤溶酶抑制剂; 血栓调节蛋白; 组织型纤溶酶原激活物-抑制剂复合物; 骨髓增生异常综合征
分类号:
R551.3；R446.11
DOI:
10.3969/j.issn.1671-7414.2025.03.026
文献标志码:
A
摘要:
目的探讨凝血酶-抗凝血酶Ⅲ复合物（TAT）、纤溶酶-α2-纤溶酶抑制剂（PIC）、血栓调节蛋白（TM）和组织型纤溶酶原激活物-抑制剂复合物（t-PAIC）对骨髓增生异常综合征（MDS）患者预后的评估价值。方法选择2018年1月～2021年1月在兵器工业五二一医院临床确诊的88例原发性MDS患者作为研究对象。检测血浆TAT，PIC，TM，t-PAIC，纤维蛋白降解产物（FDP）和D-二聚体（D-D）水平。使用多变量方法来分析总生存期（OS）与每个凝血标志物表达水平之间的关联。将与OS显著相关的凝血标志物用于构建凝血预后评分系统，并根据凝血标志物评分的中值将MDS患者分为高评分组和低评分组。使用Kaplan-Meier分析绘制了生存曲线。结果TAT（OR=1.667），PIC（OR=0.734），TM（OR=1.294），t-PAIC（OR=1.523）是MDS患者OS的独立影响因素（Waldχ2=0.671～10.751，均P<0.05）。将β值整合为统计权重并构建凝血标志物分数，计算公式如下：[TAT]×0.502-[PIC]×1.013+[TM]×0.181+[t-PAIC]×0.381。高凝血标志物评分组患者的OS（中位数14.6个月）和无白血病生存期（LFS）（中位数10.3个月）低于低凝血标志物评分组（33.6，35.2个月）的患者，差异具有统计学意义（Logrankχ2=20.57，26.84，均P<0.001）。亚组分析表明，在修正国际预后评分系统(IPSS-R)低风险（极低、低和中等风险）亚组和IPSS-R高风险（高和非常高风险）亚组中，高凝血标志物评分组的OS（Logrankχ2=9.12，4.30）和LFS（Logrankχ2=4.54，8.51）低于低凝血标志物评分组（均P<0.05）。双变量分析显示，凝血标志物评分与IPSS-R之间存在中等相关性（PCC=0.536，P<0.001）。多变量分析显示，IPSS-R和高凝血标志物评分是MDS患者OS和LFS的独立危险因素（P<0.05）。结论基于TAT，PIC，TM，t-PAIC构建的凝血标志物评分可作为MDS患者OS和LFS的独立预后因素。
Abstract:
Objective To investigate the prognostic value of thrombin-antithrombin III complex (TAT)，plasmin-α2-plasmin inhibitor complex (PIC)，thrombomodulin (TM) and tissue plasminogen activator-inhibitor complex (t-PAIC) in patients with myelodysplastic syndrome (MDS). Methods Selected 88 primary MDS patients diagnosed at the 521 Hospital of Ordnance Industry from January 2018 to January 2021. Plasma levels of TAT，PIC，TM，t-PAIC, fibrin degradation products (FDP) and D-dimer (D-D) were measured. A multivariate approach was used to analyze the association between overall survival (OS) and the levels of each coagulation marker. Coagulation markers significantly associated with OS were used to construct a coagulation prognostic scoring system. Based on the median coagulation marker score, MDS patients were divided into high and low score groups. Kaplan-Meier analysis was used to plot survival curves. Results TAT (OR=1.667), PIC (OR=0.734), TM (OR=1.294)and t-PAIC (OR=1.523) were independent factors influencing OS in MDS patients (Wald χ2=0.671～10.751，all P<0.05). The β-values were integrated as statistical weights to construct a coagulation marker score, calculated as follows: [TAT] × 0.502 -[PIC] × 1.013 + [TM] × 0.181 + [t-PAIC] × 0.381. The OS (median 14.6 months) and leukemia free survival (LFS) (median 10.3 months) of patients in the high coagulation marker score group were significantly lower than those in the low score group （33.6 months，35.2 months）(Log rank=20.57, 26.84, all P<0.001). Subgroup analysis indicated that in both the low-risk IPSS-R subgroup (very low, low, and intermediate risk) and the high-risk IPSS-R subgroup (high and very high risk), the OS (Log rank=9.12, 4.30) and LFS (Log rank=4.54, 8.51) of the high coagulation marker score group were lower than those of the low score group (all P<0.05). Bivariate analysis showed a moderate correlation between the coagulation marker score and Revise International Prognostic Scoring System（IPSS-R）(PCC = 0.536, P<0.001). Multivariate analysis indicated that IPSS-R and high coagulation marker scores were independent risk factors for OS and LFS in MDS patients (P<0.05). Conclusion The coagulation marker score, based on TAT，PIC，TM and t-PAIC, can serve as an independent prognostic factor for OS and LFS in MDS patients.

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备注/Memo

备注/Memo:
基金项目：陕西省卫生健康科研基金项目(20210449)。
作者简介：刘静静（1983-），女，硕士，副主任医师，研究方向：特发性血小板减少性紫癜、再生障碍性贫血，E-mail：hgh2025@163.com。
通讯作者：王春莹（1984-），女，硕士研究生，副主任医师，研究方向：消化系统疾病，E-mail：kine897@163.com。
更新日期/Last Update: 2025-05-15