儿童急性淋巴细胞白血病微小残留病与复发的相关分析  

Relationship Between Relapse and Minimal Residual Disease in Childhood Acute Lymphoblastic Leukemia

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

机构地区：[1]中山医科大学孙逸仙纪念医院儿科,广东广州510120

出　　处：《中国当代儿科杂志》2002年第3期171-173,共3页Chinese Journal of Contemporary Pediatrics

基　　金：广东省卫生厅科研基金资助项目 (No .A199714 8)

摘　　要：目的　分析小儿急性淋巴细胞白血病 (急淋 )缓解时和缓解不同时期微小残留病 (MRD)的水平与复发的相关性。方法　用极限稀释定量PCR法和巢式PCR法追踪检测MRD ,数据处理用Kaplan Meier方法及COX回归模型等。结果　 4 6例急淋患儿缓解时MRD值与骨髓复发呈正相关 (r =0 .4 396 ,P <0 .0 1) ,骨髓复发组MRD值为 7.35 9× 10 -3 ,与未复发组MRD值 (3.95 4× 10 -4)差异有显著性 (P <0 .0 1) ;缓解期MRD持续阳性或由阴性转为阳性者 ,骨髓复发的相对危险度明显增高 (P <0 .0 5 )。结论　缓解时MRD水平及缓解期MRD定性结果可作为估计急淋预后的一个重要指标 。Objective To study the relationship between bone marrow relapse and the level or changes of minimal residual disease (MRD) in childhood acute lymphoblastic leukemia (ALL). Methods The MRD level was detected using the modified limiting dilation PCR and nested PCR in 46 children with ALL; the data was analyzed using the Kaplan Meier method and COX model. Results The MRD level of the 46 patients by the time of complete remission (CR) was positively correlated with marrow relapse (r= 0.4396 ,P< 0.05 ). There was a significant difference in the MRD level between marrow relapse children and non relapse children ( 7.359 ×10 -3 vs 3.954 ×10 -4 ; P< 0.05 ). The cases whose MRD was persistently positive or changed from negative to positive during CR had a higher relative risk for relapse (P< 0.05 ). Conclusions The MRD level by the time of CR and the qualitative findings in the period of CR are important markers in accessing the prognosis in childhood ALL. MRD detection by PCR can be used to identify the relative risk for relapse and make more effective treatment and prophylaxis regimens for relapse in childhood ALL.

关 键 词：急性淋巴细胞白血病 微小残留病 复发 儿童 相关性 MRD 

分 类 号：R733.71[医药卫生—肿瘤]