闽南地区急性淋巴细胞白血病患儿亚甲基四氢叶酸还原酶基因多态性与甲氨蝶呤的相关性  

Correlation between methylenetetrahydrofolate reductase gene polymorphism and Methotrexate toxicity in pediatric acute lymphoblastic leukemia in southern Fujian

作　　者：陈先睿[1] 温红[1] 郭碧赟[1] 白海涛[1] 吴谨准[1] 黄建琪[1] 王玥[1] Chen Xiartrui;Wen Hong;Guo Biyun;Bai Haitao;Wu Jinzhun;Huang Jianqi;Wang Yue(Department of Pediatrics, the First Affiliated Hospital of Xiamen University, Xiamen 361000, Fujian Province, China)

机构地区：[1]厦门大学附属第一医院儿科,361000

出　　处：《中华实用儿科临床杂志》2019年第14期1068-1071,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：厦门市科学技术局科技惠民项目(3502Z20164007).

摘　　要：目的研究亚甲基四氢叶酸还原酶(MTHFR)基因C677T及A1298C位点多态性与闽南地区儿童急性淋巴细胞白血病(ALL)化疗用药甲氨蝶呤(MTX)不良反应易感性的相关性。方法选取2015年1月至2018年6月厦门大学附属第一医院儿科收治的128例闽南地区ALL患儿,采集其外周血2 mL,提取基因组DNA,采用聚合酶链反应(PCR)直接测序方法检测MTHFR基因C677T和A1298C基因型,依据国立癌症研究所毒性判定标准评估ALL患儿MTX不良反应。结果128例患儿中,54例(42.2%)出现皮疹,48例(37.5%)出现黏膜损害,51例(39.8%)出现肝损害,23例(18.0%)出现肾损害,52例(40.6%)出现胃肠道反应,38例(29.7%)出现白细胞减少,34例(26.6%)出现血小板减少,63例(49.2%)出现血红蛋白下降。MTHFR C677T和A1298C基因不同基因型组的MTX化疗不良反应(皮疹、黏膜损害、肝肾损害、胃肠道反应、白细胞减少、血红蛋白下降和血小板减少)的发生率比较差异均无统计学意义(均P>0.05)。患儿不同临床危险度(MTX剂量)分组在MTHFR C677T和A1298C的基因型和等位基因频率中分布差异无统计学意义(χ^2=2.573、2.264、1.615、0.267,均P>0.05)。24 h、48 h和72 h MTX血药浓度异常发生率差异无统计学意义(均P>0.05)。结论MTHFR的C677T和A1298C多态性可能不是预测闽南地区儿童ALL MTX化疗的良好指标,其临床应用仍需进一步探讨。Objective To explore the association between methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C gene polymorphisms and toxicity of Methotrexate(MTX) chemotherapy in pediatric acute lymphoblastic leukemia (ALL). Methods From January 2015 to June 2018, 128 pediatric patients with ALL in southern Fujian who were admitted at the First Affiliated Hospital of Xiamen University were selected.Their peripheral blood 2 mL was collected and genomic DNA was extracted.The MTHFR genotype was detected by polymerase chain reaction(PCR) direct sequencing method, and the clinical significance of HD-MTX on ALL children with toxic and side effects was evaluated according to the National Cancer Institute-Common Toxicity Criteria. Results Among 128 children, 54 cases(42.2%) presented rash, 48 cases (37.5%)with mucosal lesions, 51 cases (39.8%) with liver function damage, 23 cases (18.0%) with renal function damage, 52 cases (40.6%) with gastrointestinal reactions, 38 cases (29.7%)with leukopenia, 34 cases (26.6%) with thrombocytopenia and 63 cases (49.2%) with hemoglobin reduction.There was no significant difference in the incidence of MTX adverse reactions (rash, mucosa lesions, liver and renal function damage, gastrointestinal reaction, leukopenia, hemoglobin decrease and thrombocytopenia) between the MTHFR C677T and A1298C polymorphisms (all P>0.05). The different clinical risk (MTX dose) of the children was not statistically signi-ficant in the MTHFR C677T and A1298C genotypes and allele frequencies (χ^2=2.573, 2.264, 1.615, 0.267;all P>0.05). There was no significant difference among the abnormal incidence of MTX at 24 h, 48 h and 72 h (all P>0.05). Conclusions MTHFR C677T and A1298C polymorphisms do not seem to be good markers of MTX-related toxicity and/or outcome in pediatric ALL in southern Fujian, and its clinical application still needs further discussion.

关 键 词：淋巴细胞白血病 急性 亚甲基四氢叶酸还原酶 甲氨蝶呤 单核昔酸多态性 

分 类 号：R733.71[医药卫生—肿瘤]