急性淋巴细胞白血病微小残留病多药耐药基因的表达  

The expression of multidrug resistance gene in acute lymphoblastic leukemia-minimal residual disease

作　　者：赵洪宁[1] 白晓玲[1] 陈君[1] 郭建华[1] 

机构地区：[1]济南军区总医院优生优育中心,250031

出　　处：《中华儿科杂志》2002年第6期324-327,共4页Chinese Journal of Pediatrics

摘　　要：目的　探讨急性淋巴细胞白血病 (简称急淋 ,ALL)微小残留病 (MRD)与肿瘤多药耐药基因mdr1 mRNA表达的关系。方法　选择本院住院及门诊的ALL患儿 33例 ,采集初治前及完全缓解 (CR)后不同时期的骨髓标本 2ml,提取DNA及RNA。用聚合酶链反应 (PCR)法扩增T细胞受体γ链 (TCRγ)单克隆性基因重排 ,以确定MRD的存在 ;同时采用反转录聚合酶链反应 (RT PCR)方法对同一份标本进行mdr1 mRNA表达的检测 ,将具有阳性特异性条带的电泳胶片用GQS 960图像处理系统软件进行定量分析 ,计算mdr1与 β2 MG的比值 ,以mdr1 / β2 MG比值≥ 0 3定为阳性表达。CR后按时进行强化治疗 ,每隔 3～ 6个月对MRDDNA及mdr1 mRNA作动态观察。结果　 (1 ) 33例ALL患儿初诊时TCRγ单克隆性基因重排阳性率为 82 % (2 7/ 33) ,完全缓解 (CR)率为 91 % (30 / 33) ,CR时MRD阳性率为 80 % (2 4 / 30 )。 (2 )随访观察 6～ 1 8个月MRD阳性率呈逐渐下降趋势 ,而mdr1 mRNA阳性表达率呈逐渐上升趋势。 (3)根据随访结果 ,将处于CR期的 2 8例患儿分为 4个组 :MRD及mdr1均阳性组 (1组 ) 7例ALL患儿有 6例复发 ;MRD及mdr1均阴性组 (4组 )ALL复发数为 0 ;MRD阳性而mdr1阴性组 (2组 ) ,8例中有 2例复发 ;MRD阴性而mdr1阳性组 (3组 ) 4例中有Objective To probe into the relationship between acute lymphoblastic leukemia minimal residual disease (ALL MRD) and the expression of tumor′s multidrug resistance gene (mdr1 mRNA), and to provide scientific basis for the powerful chemotherapeutic measures to be taken for eliminating minimal residual leukemia cells (MRLC). Methods A total of 33 children with ALL were included in this study. They were both in patients and outpatients in this hospital. Their bone marrow samples were collected before chemotherapy and during different periods after complete remission (CR). Their DNAs and RNAs were extracted. The fragments of TCRγ monoclonal gene rearrangements were amplified by PCR to determine MRD. At the same time, the mdr1 mRNA expressions of the same samples were detected by RT PCR. Electrophoresis gel with the specific positive bands was quantified by GQS 960 image processing system software. The ratio of mdr1 expression to β 2 MG value was calculated. The ratio equal or over 0.3 was regarded as positive expression. The intensive treatment was conducted on schedule after CR. The levels of MRD and mdr1 mRNA were observed dynamically once every 3 to 6 months. Results (1) Twenty seven out of 33 cases with ALL were of TCRγ monoclonal gene rearrangements before chemotherapy. The detective rate was 82%. The CR rate was 91% (30/33) and the positive rate of MRD was 80% (24/30) at CR. (2) The positive rate of MRD lowered gradually during the following up of 6 to 18 months, while the positive expression rate of mdr1 mRNA got high gradually. (3) According to the following up results, 28 patients with ALL were divided into 4 groups. Six out of 7 cases of ALL were relapsed in MRD ++mdr1 + group (the 1st group), 0 out of 9 in MRD -+mdr1 - group (the 4th group), 2 out of 8 in MRD ++mdr1 - group (the 2 nd group) and 1 out of 4 in MRD -+mdr1 + group (the 3rd group). There was a significant difference in relaping rate between the 1st group and the 4th group ( P <0.05), and no obvious difference w

关 键 词：急性淋巴细胞白血病 微小残留病 多药耐药基因 MDR ALL 基因表达 化疗 聚合酶链反应 

分 类 号：R733.71[医药卫生—肿瘤]