摘要
Abstract
Objective:To establish a predictive model of poor graft function(PGF)after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with severe aplastic anemia(SAA),in order to further explore the risk factors affecting the occurrence of PGF.Methods:The clinical data of SAA patients who received allo-HSCT in the Department of Hematology of the Third People's Hospital of Zhengzhou from January 2020 to May 2024 were preliminary screened.According inclusion and exclusion criteria,258 eligible SAA patients were finally included as the study subjects.According to the evaluation results of implantation function after transplantation,258 SAA patients were divided into poor graft function group(PGF group,n=28)and good graft function group(GGF group,n=230).The general data and clinical characteristics between the PGF group and the GGF group were compared,and the variables with differences were included in the Logistic regression model to analyze the risk factors of PGF after allo-HSCT in SAA patients.The rms program in R software was used to construct the nomogram prediction model,and the receiver operating characteristic(ROC)curve was drawn.The practicability of the model was evaluated by area under the ROC curve(AUC)and Hosmer-Lemeshow test.Results:Binary Logistic regression analysis showed that haploidentical transplantation,non-relative hematopoietic stem cell donors,increased ferritin before transplantation,decreased number of CD34+cells infused and cytomegalovirus(CMV)infection were risk factors for PGF after allo-HSCT in SAA patients(P＜0.05).According to the nomogram model,the transplantation method was haploidentical,the hematopoietic stem cell provider was non-relative,the ferritin increased before transplantation,the number of infused CD34+cells decreased and CMV infection occurred.The corresponding score of the nomogram model also increased,and the incidence of PGF increased.C-index was 0.793(95％CI:0.757-0.884).ROC curve was drawn to evaluate the predictive value of the nomogram of PGF after allo-HSCT in SAA patients.The results showed that the AUC was 0.883(95％CI:0.785-0.902),the specificity was 83.00％,and the sensitivity was 92.20％(Z=10.536,P＜0.05).Hosmer-Lemeshow goodness of fit test=9.020,P=0.401,suggesting that the nomogram model has good discrimination and consistency in predicting the occurrence of PGF after allo-HSCT in SAA patients.Conclusions:The nomogram based on haploidentical transplantation,non-relative hematopoietic stem cell donors,increased ferritin before transplantation,decreased number of CD34+cells infused and CMV infection has a high predictive value for PGF after allo-HSCT in SAA patients,which provides an important reference for individualized treatment of SAA patients.关键词
异基因造血干细胞移植/再生障碍性贫血/术后植入功能不良/预测模型Key words
Allogeneic hematopoietic stem cell transplantation/Severe aplastic anemia/Poor graft function/Predictive model分类
临床医学
