评分法研究复发急性白血病再生耐药现象  

Investigation of marking phenomenon of regrowth drug resistance in relapsed acute myelogenous leukemia

作　　者：陈燕[1] 何明生[1] 吴裕丹[1] 李慧玉[1] 喻东姣[1] 

机构地区：[1]同济医科大学附属协和医院血液病研究所,武汉430022

出　　处：《癌症》1999年第6期720-723,共4页Chinese Journal of Cancer

基　　金：卫生部科学研究基金!资助 ( 1996 -2 -10 8)

摘　　要：目的 :建立评价急性髓性白血病 (AML)再生耐药的方法。材料和方法 :用白血病祖细胞培养(CFU L) ,MTT药物敏感试验 ,细胞周期中S期细胞百分比 (S % ) ,细胞内柔红霉素 (DNR)测定其荧光指数 (FI)和耐药指数 (DRI) ,APAAP法测P 170糖蛋白表达以及半定量RT PCR检测Bcl XLmRNA表达丰度 ,评价AML细胞的药物敏感程度和增殖情况。首先选取初治AML病例研究评分指标与细胞耐药和细胞生长的相关性 ,其次对2 0例复发AML病例进行再生耐药评分。评分方法 :①评分条件 :患者有临床耐药表现 ,同时检测细胞药敏和细胞增殖情况 ;②评分标准 :细胞药敏检测其结果为药敏评为 2分 ,反之评为 1分 ;细胞增殖检测细胞为细胞增殖过快评为 2分 ,反之评为 1分 ;凋亡抑制基因高表达评为 2分 ,反之评为 1分 ;③AML再生耐药评价 :<7分不属于再生耐药 ,≥ 7分可能存在再生耐药 ,≥ 9分为再生耐药。结果 :2 0例复发AML中 ,9例评为再生耐药。结论 :初步建立了再生耐药的评分方法 ;复发AML中存在再生耐药 ,克服再生耐药对确立新的治疗方案具有重要的临床意义。Objective:To develop the method for evaluation of regrowth drug resistance in relapsed acute myelogenous leukemia (AML). Methods:Drug sensitivity and proliferation of leukemic cells in vitro were determined by leukemic cell colony forming unit (CUF L),MTT drug sensitive test, percentage of S phase cells in cell cycle (S%), fluorescent index(FI) and drug resistant index (DRI) by detecting intracellular daunorubicin, expression of P 170 glycoprotein by APAAP assay, and abundance of bcl XL mRNA by semiquantitative reverse transcription polymerase chain reaction (RT PCR). Firstly, the correlation between scoring criteria and cell drug resistance and cell proliferation was investigated in newly untreated AML. Secondly, 20 patients with relapsed AML were marked. According to each tested result, its point(s) was scored, which the scoring methods were ①, eligibility:the subject's clinically drug resistant manifestation; both drug sensitive and cell proliferative tests would at once be carried out; ②, scoring criteria:drug sensitive or cell proliferative result was scored 2 points, otherwise scored one point; overexperssion of antiapoptotic gene was scored 2 points, otherwise scored one point; ③,evaluation for regrowth drug resistance in AML:< 7 points for no regrowth drug resistance,≥7 points for the probability of regrowth drug resistance, and ≥9 points for regrowth drug resistance. Results:Scoring criteria studied were related to cell drug resistance or cell proliferation. Nine cases out of 20 relapsed AML were diagnosed as obviously regrowth drug resistance with this scoring method. Conclusions:The scoring method for regrowth drug resistance was first developed in AML. There was regrowth drug resistance in relapsed AML; clinically circumventing it would be of extreme signifiance for establishment of new approaches to the treatment in AML.

关 键 词：再生耐药 急性白血病 细胞增殖 评分标准 

分 类 号：R733.71[医药卫生—肿瘤]