| Myelodysplastic syndromes(MDS)is a clonal heterogeneous disease that originates from hematopoietic stem cells.It has the characteristics of abnormal proliferation of bone marrow cells,ineffective hematopoietic,and high conversion to acute myeloid leukemia(AML).It is difficult to identify early patients without obvious pathological hematopoiesis or typical chromosome or gene mutation or the original cells less than 5%.In addition,the acquisition of diagnostic indicators has high requirements on technology and conditions,which has caused incomplete development in most hospitals,which has also affected the early diagnosis of MDS.Even if the diagnosis can be confirmed,the evaluation of the prognosis of MDS is also a major problem faced with primary hospitals,At present,the revised international prognostic scoring system are the most widely used methods to evaluate the prognosis of MDS.But karyotyping is the most important parameter for IPSS-R stratification.The verification process takes a long time and costs more,it also has high requirements for the detection environment and technology,which makes its application limited.In addition,even patients in the same risk stratum have different survival times.Therefore,early identification and accurate assessment of prognosis is still a major problem in the diagnosis and treatment of MDS.The detection of serum ferritin(SF),lactate dehydrogenase(LDH),and WT-1 genes has been widely carried out in clinical practice,and the results are easy to obtain,with the advantages of high sensitivity and reproducibility,which is better blood Cancer research indicators.Objective:By studying the differences of SF,LDH,and WT-1 in patients between MDS and AA,and the relationship between the levels of SF,LDH,and WT-1 and IPSS-R grouping?survival time in MDS patients,it provides early guidance for the diagnosis and prognosis of MDS.Methods:1.A retrospective analysis method was used,numbers of 96 diagnosed MDS patients who were admitted to the Endocrinology Department of the First Central Hospital of Baoding City from May 2015 to October 2018 was collected as the experimental group.Numbers of 74 diagnosed AA subjects during the same period were the control group The experimental group was divided into a lower risk group(n=45)and a higher risk group(n=51)according to IPSS-R.2.Sex,age,underlying disease,ECOG performance status score and SF,LDH and WT-1 levels of all subjects were collected.The differences of SF,LDH,and WT-1 in MDS and AA were analyzed,and the optimal cutoff value and diagnostic efficacy of SF,LDH,and WT-1 in the diagnosis of MDS were studied.3.Analyze the differences between SF,LDH,and WT-1 in the IPSS-R higher-risk group and lower-risk group,and study the relationship between different combinations of SF,LDH,and WT-1 and patient survival time in the higher-risk group and the lower-risk group.Using COX risk proportion model to analyze the prognosis of SF,LDH,and WT-1 by multivariate factors.Results:1.MDS group compared with AA group patients:The difference was not statistically significant in general information such as gender,age,and ECOG performance status score between MDS and AA(p> 0.05).SF,LDH,and WT-1 levels in MDS group were significantly higher than those in AA group,and the differences were statistically significant(p <0.05).2.Analysis of ROC curve :The area under the SF curve is 0.640,the best cutoff value is 402.33ng/ml,the sensitivity is 57.3%,and the specificity is 68.9%.The area under the LDH curve is 0.770,the best cutoff value is 213.75U/L,the sensitivity is 60.4%,and the specificity is 67.6%.The area under the WT-1 curve is 0.848,the best cutoff is 0.15,the sensitivity is 75.0%,and the specificity is 89%.By comparing the area under each index curve,WT-1 has the best efficacy in differential diagnosis.The area of indicator which was combined by SF,LDH and WT-1 was 0.872,and it was larger than the area under the curve of the indicator which applied alone.3.Among patients with MDS,SF,LDH,and WT-1 levels were higher in patients at IPSS-R higher risk groups than that which at IPSS-R lower risk groups,and the differences were statistically significant(p <0.05).4.Survival analysis of MDS patients in IPSS-R lower-risk group: When the three indexes of SF,LDH,and WT-1 are lower than the diagnostic threshold in the IPSS-R lower-risk group,the OS is 36.50 months;When the cutoff value was diagnosed,the OS was 28.60 months;when the two indexes were high,the OS was 22.35 months;when the three indexes were high,the OS was 20.30 months,and the difference was statistically significant(p <0.05).5.Survival analysis of MDS patients in the IPSS-R higher-risk group: In the IPSS-R higher-risk group,at least one of the three indicators of SF,LDH,and WT-1 is higher than the diagnostic threshold;when one indicator is high,the OS is 19.50 months When the two indicators are high,the OS is 14.05 months;when the three indicators are high,the OS is only 11.00 months,and the difference is statistically significant(p <0.05).6.Prognosis analysis of multivariate: Multivariate analysis by COX proportional hazard model showed that SF(RR = 2.298,95% CI1.430-3.692,p = 0.001),LDH(RR = 1.897,95% CI 1.186-3.032,p = 0.008)and WT-1(RR = 2.941,95% CI 1.702-5.083,p <0.001)are risk factors that affect the survival time of patients with MDS.Conclusion:1.MDS patients have higher levels of SF,LDH,and WT-1 than patients with AA,SF above 402.33ng/ml,LDH above 213.75 U/L,and WT-1 above 0.15%,which has an important reference value for the early diagnosis of MDS.2.All MDS patients in the higher-risk group and the lower-risk group,patients with higher levels than the optimal diagnosis threshold of SF,LDH,and WT-1have a poor prognosis.3.SF,LDH,and WT-1 are risk factors that affect the prognosis of MDS patients.These three indicators can be used as potential evaluation indicators to evaluate the prognosis of patients. |
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