骨髓增生异常综合征患者KIR基因多态性与中西医结合治疗疗效的相关性研究  

Study on the relationship between polymorphsim of KIR genes in patients with myelodysplastic syndrome and therapeutic effect of integrated Chinese and western medicine

作　　者：陈海琳[1] 周永明[1] 朱文伟[1] 周韶虹[1] 许毅[1] 胡明辉[1] 李艳[1] 王婕[1] 孙伟玲[1] 鲍计章[1] 胡令彦[1] 陆皓[1] 曾庆[1] 董萍萍 CHEN Hailin;ZHOU Yongming;ZHU Wenwei;ZHOU Shaohong;XU Yi;HU Minghui;LI Yan;WANG Jie;SUN Weiling;BAO Jizhang;HU Lingyan;LU Hao;ZENG Qing;DONG Pingping(Department of Hematology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院血液科,上海200437

出　　处：《上海中医药大学学报》2020年第5期19-25,共7页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(81673939);国家中医药管理局中医临床研究基地业务建设科研专项项目(JDZX2015261);上海市名老中医学术经验研究工作室项目(SHGZS-2017019);上海中医药大学名老中医药专家学术经验研究工作室建设项目(SZYMZYGZS4018)。

摘　　要：目的:比较骨髓增生异常综合征(MDS)患者与正常健康者杀伤细胞免疫球蛋白样受体(KIR)基因多态性的差别,探讨采用中西医结合疗法治疗MDS的疗效应答与KIR基因多态性的相关性。方法:纳入MDS患者30例(包括正虚毒蕴型17例、毒盛正虚型13例)及健康对照者15例,采用序列特异性引物聚合酶链法检测MDS患者和健康对照者的KIR基因型,分析、比较其差异。采用健脾补肾解毒方加减结合西医常规疗法治疗MDS,治疗6个月后,评价临床疗效,并探讨对治疗有应答者与无应答者KIR基因型的差异。结果:与正常对照者比较,MDS患者的KIR 2DS3、2DS4表达频率显著升高(P<0.05)。治疗后,30例MDS患者的总有效率为86.67%,对治疗有应答者26例、无应答者4例,有应答者的KIR 2DS1基因表达频率显著高于无应答者(P<0.05)。结论:KIR基因多态性可能与MDS发病相关,KIR活化型基因2DS3、2DS4高表达可能是MDS的易感因素;KIR 2DS1基因表达缺乏患者可能对当前中西医结合治疗方案不易产生应答。Objective: To compare the difference of killer cell immunoglobulin-like receptor(KIR) gene polymorphism between the patients with myelodysplastic syndrome(MDS) and the healthy volunteers, and discuss the relationship between the therapeutic response of integrated Chinese and western medicine and the KIR gene polymorphism in patients with MDS. Methods:Thirty patients with MDS(including 17 cases with syndrome of toxin accumulation due to deficient vital qi and 13 cases with syndrome of excessive toxin due to deficient vital qi) and fifteen healthy control subjects were included. The KIR genotypes of MDS patients and healthy control subjects were detected by sequence-specific primer polymerase chain reaction(PCR-SSP), and the differences of KIR genotypes were analyzed and compared. The patients with MDS were treated with modified Jianpi Bushen Jiedu Recipe combined with conventional western medicine. After treatment for 6 months, the clinical efficacy was evaluated, and the differences of KIR genotypes between the patients with or without therapeutic response were explored. Results:Compared with the normal control subjects, the expression frequency of KIR 2 DS3 and 2 DS4 genes in MDS patients was significantly increased(P<0.05).After treatment,the total effective rate of 30 patients with MDS was 86.67%.There were 26 patients with therapeutic response and 4 patients without therapeutic response,and the expression frequency of KIR 2DS1gene in patients with therapeutic response was significantly higher than that in patients without therapeutic response (P<0.05).Conclusion:KIR gene polymorphism may be related to the pathogenesis of MDS.The high expressions of KIR activated genes 2DS3 and2DS4 may be the predisposing factors for MDS.Patients with KIR 2DS1 gene expression deficiency may not be easy to respond to the current therapeutic regimen of integrated Chinese and western medicine.

关 键 词：骨髓增生异常综合征 KIR 基因多态性 中西医结合 

分 类 号：R551.3[医药卫生—血液循环系统疾病]