急性髓系白血病流式微小残留病与形态学缓解度、遗传学相关性研究及预后评估的价值  

The value of minimal residual disease with acute myeloid leukemia in prognostic evaluation and its correlation with cell morphology and genetics

作　　者：莫伟明[1] 刘军[1] 窦琳琳[1] 陈琴琴[1] 

机构地区：[1]浙江萧山医院检验科,杭州311202

出　　处：《中国医师杂志》2017年第5期701-704,共4页Journal of Chinese Physician

基　　金：杭州市萧山区社会发展重大科技攻关项目（2016204）

摘　　要：目的探讨急性髓系白血病（AML）首次化疗后流式微小残留病（MRD）与细胞形态学、遗传学相关性研究及预后评估中的价值探讨。方法收集105例AML（非M3）为研究对象，评价首次化疔后MRD水平与细胞形态学缓解度、遗传学的相关性分布状况；对其中78例完全缓解（CR）的患者依据不同MRD水平分组，评价一年期复发率。结果105例AML首次化疗后MRD水平与形态学缓解度相关性分布评价中，细胞形态学78例（74．29％）CR，27例（25．71％）部分缓解（PR）或无缓解（NR）；其78例CR中，MRD（-）66．67％（52／78），MRD（＋）33．33％（26／78）；而27例NR或PR，MRD（＋）100．00％（27／27）。MRD水平与细胞遗传学相关性分布评价中，首次化疗后细胞遗传学预后较好组、预后中等组、预后较差组MRD（-）率分别为66．67％、45．90％、35．29％，差异无统计学意义（P〉0．05）。对78例AML—CR依据MRD水平分组评价一年期复发率，MRD（＋）组复发率明显高于MRD（-）组，差异有统计学意义（P〈0．05）。结论随着血液学的发展，CR含义的不断深入，运用流式细胞术检测MRD，MRD（＋）比传统细胞形态学复发出现早，对指导治疗及早期预测复发具有重要的评估价值。Objective To explore the value of minimal residual disease with acute myeloid leukemia in prognostic evaluation and its correlation with cell morphology and genetics. Methods A total of 105 patients with acute myeloid leukemia （AML） （non M3） was used as the research subjects to evaluate the correlation between the level of minimal residual disease （MRD） and the degree of cellular morphological remission, and cytogenetics. According to the different levels of MRD, 78 patients of cell morphology com- plete remission （CR） were grouped to evaluate the one-year recurrence rate after the first chemotherapy treatment. Results The correlation was evaluated between MRD level and morphological remission in 105 patients with AML after initial chemotherapy. In the degree of cellular morphological remission cell evalua- tion showed 78 （74. 29% ） cases of CR, 27 （25. 71% ） cases of partial remission （PR） or non remission （NR）. Among 78 cases of CR, MRD negative rate was 66. 67% （52/78）, MRD was 33.33% （26/78） ; and 27 cases of NR or PR, MRD was 100% （27/27）. The correlation between MRD level and cytogenetic evaluation, cytogenetic prognosis group and prognosis of middle group and poor prognosis group, and the negative rate of MRD were 66. 67%, 45.90%, and 35.29%, without significant difference （ P 〉 0. 05 ）. Seventy eight patients with CR were divided into two groups according to the level of MRD to evaluate the re- currence rate of the 1 year, the recurrence rate of the positive group was significantly higher than that of the negative group （P 〈 0. 05）. Conclusions With the development of hematology, the meaning of CR deep- ly, using flow cytometry method to detect the MRD, MRD positive ceils relapse earlier than the traditional morphology, it has important clinical significance for guiding treatment and early prediction of recurrence of CR AML.

关 键 词：白血病 髓样 急性/药物疗法 肿瘤 残余 遗传学 预后 

分 类 号：R730.43[医药卫生—肿瘤] R733.71[医药卫生—临床医学]