急性淋巴细胞白血病患者中T细胞受体基因重排的检测  

Detection of TCRVγI-Jγ gene rearrangement in acute lymphoblastic leukemia patients

作　　者：陈玉清[1] 李琳[2] 王龙安[2] 时杰[1] 白炎亮[1] 臧玉柱[1] 张茵[1] 

机构地区：[1]河南省人民医院血液科,郑州450003 [2]河南省人民医院急诊医学部

出　　处：《医药论坛杂志》2012年第2期11-13,16,共4页Journal of Medical Forum

基　　金：河南省科技厅科技攻关重点项目(112102310585)

摘　　要：目的为了解急性淋巴细胞白血病(ALL)患者T细胞受体(TCR)基因重排情况,明确TCR基因重排在ALL患者微小残留病(MRD)检测中的临床意义。方法构建实时荧光定量聚合酶链反应(PCR)检测TCRVγI-Jγ基因重排技术,并定量分析36例ALL患者,观察治疗前、完全缓解后以及干细胞移植后等不同疾病状态下TCRVγI-Jγ基因重排情况。结果建立实时荧光定量PCR方法的灵敏度为10-4水平。36例患者荧光定量PCR方法检测结果为初治组为(7.38±6.65)×10-2水平,完全缓解(CR)组为(1.08±1.02)×10-2水平,造血干细胞移植术(HSCT)组为(5.65±3.89)×10-3水平。CR组和HSCT组TCRVγI-Jγ基因重排水平显著低于初治组(P<0.01),HSCT组MRD水平显著低于CR组(P<0.05)。6例HSCT后检测阳性病例中2例MRD水平<1×10-3,此2例获长期无病生存,另4例MRD水平较高患者1年内均出现复发。结论所建立实时荧光定量PCR方法简便、快速、灵敏及特异;实时荧光定量检测缓解期ALL患者MRD对判断预后具有重要意义。Objective To improve the clinical significance of detection of minimal residual disease（MRD） in acute lymphoblastic leukemia（ALL）.Methods A real time quantitative PCR method was constructed for quantitative clonal TCRVγI-Jγ gene rearrangement in 36 ALL cases.Results The sensitivity of the established real time quantitative PCR were 10-4 level.The amount of TCRVγI-Jγ gene rearrangement in newly diagnosis group,complete remission（CR） group and after hematopoietic stem cell transplantation（HSCT） group were（7.38±6.65）×10-2,（1.08±1.02）×10-2 and（5.65±3.89）×10-3 level.The amount of TCRVγI-Jγ gene rearrangement of ALL patients in newly diagnosis group is higher than that in CR group and HSCT group（P0.01）.The MRD level of ALL patients in CR group is higher than that in HSCT group（P0.05）.MRD can be detected in 6 ALL patients after HSCT,2 cases with low MRD level（1×10-3） received long disease-free survival.The other 4 cases with high MRD level all suffer relapse within one year.Conclusions The established real time quantitative PCR assay is simple,repaid,sensitive and specificity.The real time quantitative PCR assay to evaluatie MRD in the remission period of All cases is more helpful for prognosis prediction.

关 键 词：急性淋巴细胞白血病 基因重排 微小残留病 

分 类 号：R733.71[医药卫生—肿瘤]