CD47分子在初诊成人急性髓系白血病患者中的表达及与临床预后的相关性  

Correlation between Expression of CD47 Molecule in Patients with Newly Diagnosed Adult Acute Myeloid Leukemia and Clinical Prognosis

作　　者：潘静 张园园 焦霞霞 宋蕾娜 林彩芹 王素丽 朱斌[3] 潘韶英 丁志勇[3] 赵文理[3] PAN Jing;ZHANG Yuan-Yuan;JIAO Xia-Xia;SONG Lei-Na;LIN Cai-Qin;WANG Su-Li;ZHU Bin;PAN Shao-Ying;DING Zhi-Yong;ZHAO Wen-Li(Anhui University of Science and Technology of Medical College,Huainan 232000,Anhui Province,China;Hubei University of Medicine,Shiyan 442000,Hubei Province,China;Department of Hematology,Shanghai Fengxian District Central Hospital,The Sixth People′s Hospital South Campus Affiliated to Shanghai Jiao Tong University,Shanghai 201400,China)

机构地区：[1]安徽理工大学医学院,安徽淮南232000 [2]湖北医药学院,湖北十堰442000 [3]上海市奉贤区中心医院,上海交通大学附属第六人民医院南院血液科,上海201400

出　　处：《中国实验血液学杂志》2022年第4期1071-1078,共8页Journal of Experimental Hematology

基　　金：上海市卫健委重点科研项目(201640028);上海市奉贤区科委重点项目(奉科20160801);上海市奉贤区第二批临床诊疗中心建设项目(fxlczlzx⁃a⁃202105)。

摘　　要：目的:探讨CD47分子在初诊成人急性髓系白血病(AML)患者中的表达及其与临床预后的相关性。方法:选择2020年4月-2021年10月上海市奉贤区中心医院诊断明确的AML患者20例,另5例非恶性血液病患者作为对照组。实时荧光定量聚合酶链式反应(qPCR)检测骨髓、外周血单个核细胞CD47的表达。结合患者初诊时血象、骨髓涂片、流式细胞术、染色体及基因检测、ECOG评分等情况,评价患者预后与CD47表达的关系。结果:与对照组比较,初诊AML患者骨髓(P=0.0115)及外周血单个核细胞(P=0.0069)中CD47表达明显升高。在骨髓单个核细胞中,CD47高表达患者总的生存时间短于CD47低表达患者(P=0.036),不同危险分层患者的生存率差异有统计学意义(P=0.012),但在外周血单个核细胞中CD47表达高、低的患者生存时间比较差异无统计学意义(P=0.116)。骨髓单个核细胞CD47表达高低组在白血病相关基因突变、存在融合基因、CD34^(+)、CD38^(+)、CD123^(+)表达等方面均无统计学意义(P>0.05)。AML患者骨髓原始细胞数比例>50%、ECOG评分>2分、存在MLLELL融合基因、染色体预后分层均为影响患者生存的危险因素(P分别为0.023、0.036、0.012、0.001)。AML患者骨髓高表达CD47提示疾病高复发风险(P=0.017)。结论:骨髓单个核细胞CD47在AML患者中表达升高,提示更差的生存和更高的复发风险。Objective:To investigate the expression of CD47 molecules in patients with newly diagnosis of adult acute myeloid leukemia(AML)and its correlation with clinical prognosis.Methods:20 patients with acute myeloid leukemia diagnosed in Shanghai Fengxian District Central hospital from April 2020 to October 2021 and 5 cases with non malignant hematological diseases in the control group were collected,and the expression of CD47 in single nuclear cells of bone marrow and peripheral blood was detected by real⁃time fluorescence quantitative polymerase chain reaction(qPCR).Combined with the blood image,bone marrow smears,flow cytometry,chromosome and gene detection,ECOG score,etc.during the patient′s initial diagnosis,the relationship between the patient′s prognosis and CD47 was evaluated.Results:The expression of CD47 in bone marrow(P=0.0115)and peripheral blood mononuclear cells(P=0.0069)in new diagnosis AML patients was significantly higher than that of controls.In bone marrow mononuclear cells,the total survival time of patients with high CD47 expression was less than that of CD47 low expression patients(P=0.036).There was statistical significance in difference stratification group(P=0.012),but there was no statistical significance between CD47 expression and survival time in peripheral blood mononuclear cells(P=0.116).There were no statistical significance between bone marrow mononuclear cell CD47 expression and gene mutation fusion genes related to leukemia,CD34^(+),CD38^(+),CD123^(+)(P>0.05).The proportion of bone marrow protocells in AML patients was>50%,the ECOG score was>2 points,MLLELL fusion gene and chromosome prognosis stratification were all risk factors affecting the survival of patients(P=0.023,0.036,0.012,0.001,respectively).The high expression of bone marrow CD47 in AML patients indicated a high risk of recurrence(P=0.017).Conclusion:The high expression of bone marrow mononuclear cell CD47 in AML patients indicates poorer survival and higher risk of recurrence.

关 键 词：成人急性髓系白血病 CD47 预后 

分 类 号：R733.71[医药卫生—肿瘤]