极限稀释PCR法对急性淋巴细胞白血病微小残留病的检测及意义  

Quantitative analysis of minimal residual disease and its clinical significance in children with acute lymphoblastic leukemia by limiting dilution assay

作　　者：郭海霞[1] 李文益[1] 邓庆丽[1] 夏焱[1] 薛红漫[1] 方建培[1] 

机构地区：[1]中山医科大学孙逸仙纪念医院儿科,广州510120

出　　处：《中华儿科杂志》1999年第11期688-690,共3页Chinese Journal of Pediatrics

基　　金：广东省卫生厅科研基金

摘　　要：目的　探讨极限稀释定量ＰＣＲ法检测追踪急性淋巴细胞白血病（ 简称急淋，ＡＬＬ） 患儿骨髓微小残留病（ＭＲＤ） 变化的临床意义。方法　改良极限稀释定量ＰＣＲ方法。结果　敏感度平均为４ 拷贝。对２３ 例初治ＭＲＤ阳性的患儿在诱导治疗达到缓解（ＣＲ） 时的ＭＲＤ 定量检测结果显示：（１）ＣＲ时ＭＲＤ阴性１０ 例，其中８ 例在追踪期内亦持续阴性，另２ 例在追踪过程中ＭＲＤ 转为阳性，经强化疗后ＭＲＤ渐减少至转阴；（２）ＣＲ时ＭＲＤ 阳性１３ 例，其中６ 例ＣＲ时ＭＲＤ平均值为０－０６４ ％ ，在缓解期ＭＲＤ值逐渐减少，直至转阴；５ 例ＣＲ时ＭＲＤ 值较高或ＣＲ期时持续高值，２ 例ＣＲ期ＭＲＤ值渐增高，此７ 例均复发；（３） 骨髓复发组（７ 例）ＣＲ 时ＭＲＤ 定量值平均为０－１５７ ％ ，未复发组（１４ 例） 为０－００３％ （Ｐ＜０－０５） 。结论　采用极限稀释定量法检测ＡＬＬ的ＭＲＤ，具有操作简单、敏感性高的优点；持续追踪ＣＲ期ＭＲＤ 对指导化疗及预测预后有重要意义。Objective To probe into the clinical significance of limiting dilution quantitative PCR in following up of the minimal residual disease (MRD) changes in patients with acute lymphoblastic leukemia (ALL) Methods A modified limiting dilution assay was applied in this study Results The average sensitivity was 4 copies MRD cells were quantitated when induction therapy achieved complete remission (CR) in 23 cases whose MRD of untreated samples were positive: (1) MRD was negative at CR in 10 cases, 8 of them kept negative during following up and 2 cases turned to positive during following up and after intensified chemotherapy, MRD decreased gradually to negative (2) MRD was positive at CR in 13 cases, in 6 cases of them the mean level of MRD was 0 064% at CR, decreased gradually and turned negative at last; MRD level of 5 case was high at CR or persistently high and in 2 cases increased gradually in CR period, the disease relapsed in all these 7 cases; (3) The average amount of MRD cell was 0 157% in marrow relapse group (7 patients) at CR and 0 003% in non relapse group (14 patients) ( P <0 05) Conclusion The method of limiting dilution quantitative assay has the advantages of simplicity, effectiveness and high sensitivity in detecting MRD in ALL It has important clinical significance of guiding chemotherapy and predicting prognosis to follow up continuously MRD in CR period

关 键 词：白血病 急性 聚合酶链反应 诊断 

分 类 号：R733.71[医药卫生—肿瘤]