急性淋巴细胞白血病微量残留病动态监测的研究  

The study of dynamic detection of minimal residual disease in children with acute lymphoblastic leukemia

作　　者：谷仁凯[1] 卢洁[1] 孙立荣[1] 董增义[1] 雷炜[1] 庞秀英[1] 佟琳如[1] 周容[1] 

机构地区：[1]青岛大学医学院附属医院儿内科

出　　处：《中华儿科杂志》1999年第5期267-270,共4页Chinese Journal of Pediatrics

摘　　要：目的探讨采用筑巢式聚合酶链反应（ＮｅｓｔｅｄＰＣＲ）等多项指标监测小儿急性淋巴细胞白血病（ＡＬＬ）微量残留病（ＭＲＤ）的临床意义。方法９８例ＡＬＬ进行了形态学、免疫学和细胞遗传学（ＭＩＣ）分型，结合ＮｅｓｔｅｄＰＣＲ、姐妹染色单体交换（ＳＣＥ）、染色体核型分析，对５８例ＡＬＬ进行ＭＲＤ监测。结果：（１）５８例ＡＬＬ进行了Ｔ细胞受体（ＴＣＲ）Ｖδ２Ｄδ３基因重排检测，在４１例ＢＡＬＬ中３４例（８３％）及４例ＴＡＬＬ中１例具有此基因重排。检测敏感度为１０－５～１０－６。（２）５８例ＡＬＬ中４４例ＡＬＬ进行了ＭＲＤＰＣＲ动态监测。结果显示，维持强化治疗期间ＰＣＲ检测由阴性转为阳性或持续阳性者，易引起骨髓复发死亡，提示预后较差。ＰＣＲ检测转阴时间有明显的个体差异性，持续完全缓解（ＣＣＲ）３年以上的ＡＬＬ患儿ＰＣＲ持续转阴可作为停用化疗药的可靠指标。（３）５０例ＡＬＬ进行了ＳＣＥ的动态监测，初发组ＳＣＥ频率高于ＣＲ组，差异有非常显著意义（Ｐ＜０．００１）。部分缓解组显著高于ＣＲ组（Ｐ＜０．０１），ＳＣＥ频率变化与疾病的严重程度呈平行关系。（４）初发ＡＬＬ中无论染色体核型正常或异常其ＳＣＥ频率均显著增高，两者?Objective To explore the clinical significance of detecting minimal residual disease (MRD) in children with acute lymphoblastic leukemia (ALL) by using the methods of nestpolymerase chain reaction (NestPCR) and other detecting indexes. Methods Based on the morphological, immunological and cytogenetic (MIC) classifications along with the detection of NestPCR, the frequency of the sister chromatid exchange (SCE) and the chromosome karyotype analysis, 98 children with ALL were classified and 58 of 98 patients with ALL were detected for MRD. Results Fiftyeight patients with ALL were detected for gene rearrangements of T cell receptor (TCR) V2D3. Thirtyfour of 41 patients with BALL (82.9%) and 1 of 4 patients with TALL were found with the gene rearrangement. The detecting senstivities of MRD were 10-510-6. Fortyfour of 58 patients with ALL were detected dynamically for MRD. During intensive therapy, the patients with the positive PCR results converted from the negative and with the persistant positive PCR results preferred to relapse in bone marrow, which would induce death and indicate a poor prognosis. The time of PCR results turned to negative was different individually. It might be an indicator of terminating chemotherapy that the MRD was undetectable in ALL patients with continued complete remission (CCR) for more than 3 years. The frequencies of SCE of bone marrow cells in 50 patients with ALL were detected dynamically. The frequencies of SCE in patients with primary ALL and patients with partial remission were higher than patients with complete remission (CR) (P<0.001 and P<0.01, respectively). The frequency of SCE was associated with the severity of the disease. In patients with primary ALL, the frequencies of SCE were increased both in the groups of normal and abnormal chromosome karyotype

关 键 词：白血病 急性 微量残留病 PCR SCE 动态监测 

分 类 号：R733.71[医药卫生—肿瘤]