Auer小体阳性与阴性初治非AML-M3型原发急性髓系白血病临床特点对比分析  

Comparative analysis of clinical characteristics between Auer body positive and negative de novo primary acute myeloid leukemia patients (non-AML-M3 type)

作　　者：姜艳红 焦扬 陈光意 盛家和 许青霞 JIANG Yan-hong;JIAO Yang;CHEN Guang-yi;SHENG Jia-he;XU Qing-xia(Clinical Laboratory,the Tumor Hospital of Zhengzhou University,Zhengzhou 450008,Henan,China)

机构地区：[1]郑州大学附属肿瘤医院检验科,河南郑州450008

出　　处：《广东医学》2020年第7期702-707,共6页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划项目(201503192)。

摘　　要：目的分析Auer小体阳性与阴性初治原发急性髓系白血病(AML)(非AML-M3型)实验室及临床特点。方法回顾性分析248例初治原发非M3型AML患者的实验室和临床资料,实验室和临床资料数据通过查阅医院电子病历获取,根据原始细胞有无Auer小体有无分为Auer小体阳性组(ARPG)和Auer小体阴性组(ARNG),所有入选患者随访至2018年12月31日,随访数据通过查阅病历或打电话获取。通过Kaplan-Meier进行生存分析,通过Log-rank test对总生存时间进行对比分析。结果一般临床特点中ARPG有心血管疾病症状患者比例低于ARNG患者,而有消化系统疾病症状比例高于ARNG患者,差异均有统计学意义(P=0.004、0.000)。实验室检查结果特点中ARPG患者FAB分型M2亚型、预后良好核型、融合基因AML-ETO和突变基因c-KIT比例高于ARNG患者(P=0.000、0.000、0.000和0.011),而FAB分型M5亚型、预后中等核型和突变基因NPM1比例低于ARNG患者,差异均有统计学意义(P=0.000、0.019和0.023)。诱导化疗结果中ARPG患者获得完全缓解(CR)的比例高于ARNG患者(P=0.015),而治疗失败的比例低于ARNG患者,差异均有统计学意义(P=0.005)。随访结果中ARPG患者中位总生存期(OS)(15个月)高于ARNG患者(11个月),差异无统计学意义(P=0.068)。结论与Auer小体阴性患者相比,Auer小体阳性患者多为FAB分型中AML1-ETO融合基因阳性的AML-M2,少见于AML-M5,常伴有消化系统疾病症状,而少有心血管系统疾病症状,预后良好核型比例较高,但预后中等核型偏低,易伴c-KIT基因突变,而NPM1突变少见,有较高的CR率,但两者的OS差异不明显。Objective To comparative analyze the laboratory and clinical features between Auer body positive and negative de novo primary acute myeloid leukemia(AML)(non-AML-M3 type) patients. Methods Laboratory and clinical data of 248 de novo primary AML patients were retrospectively reviewed. According to the presence or absence of Auer body in the original cells, the patients were divided into Auer body positive group(ARPG) and Auer body negative group(ANPG), All patients were followed up until December 31, 2018, and the follow-up data was obtained by consulting medical records or by telephone. Survival analysis was performed by Kaplan-Meier method, and total survival time was compared by Log-rank test. Results In general clinical features, the proportion of ARPG patients with cardiovascular disease symptoms was significantly lower than ARNG patients(P=0.004);but the proportion of symptoms of digestive diseases was significantly higher than that of patients with ARNG(P=0.000). In the laboratory characteristics, the proportions of ARPG patients with AML-M2 subtype, good prognosis karyotype, fusion gene AML1-ETO and mutation gene c-KIT were significantly higher than ARNG patients(P values were 0.000, 0.000, 0.000, and 0.011, respectively);but the proportions of AML-M5, moderate prognosis and mutated gene NPM1 were significantly lower than ARNG patients(P values were 0.000, 0.019 and 0.023, respectively). In the results of induction chemotherapy, ARPG patients had a significantly higher rate of CR than ARNG patients(P=0.015);but the proportion of treatment failure was significantly lower than that of ARNG patients(P=0.005). The median OS(15 months) in ARPG patients was higher than that in ARNG patients(11 months), but the difference was not statistically significant. Conclusion Compared with Auer body negative patients, Auer body positive patients are mostly AML-M2 in FAB typing with fusion gene AML1-ETO positive, which are rare in AML-M5;they are accompanied by symptoms of digestive diseases, but less cardiovascular system

关 键 词：AUER小体 急性髓系白血病 临床特征 

分 类 号：R733.71[医药卫生—肿瘤] R446[医药卫生—临床医学]