急性淋巴细胞白血病患儿WT1基因表达及其临床特点  

The expression of WT1 gene and its clinical characteristics in children with acute lymphoblastic leukemia

作　　者：尹萌萌[1] 刘爱国[1] 张艾[1] 王雅琴[1] 胡群[1] Yin Mengmeng;Liu Aiguo;Zhang Ai;Wang Yaqin;Hu Qun(Department of Pediatric Hematology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院儿童血液科,武汉430030

出　　处：《中国医师进修杂志》2023年第1期46-51,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的观察急性淋巴细胞白血病(ALL)患儿WT1基因的表达情况,并分析其临床表现和与预后的相关性。方法回顾性分析2015年1月至2019年5月华中科技大学同济医学院附属同济医院183例新诊断ALL患儿的临床资料。采用实时荧光定量聚合酶链反应技术检测骨髓标本中WT1基因的表达水平。患儿随访至2021年6月,中位随访时间为46(0~63)个月。结果 183例ALL患儿中,WT1基因阳性130例(71.04%),表达水平1.41%(0.26%,6.73%);WT1基因阴性53例(28.96%)。T淋巴细胞白血病(T-ALL)、非高二倍体和中高危患儿WT1基因表达水平明显升高,差异有统计学意义(P<0.05或<0.01);而不同性别、染色体核型、肝脾肿大和初诊时白细胞计数患儿WT1基因表达水平比较差异无统计学意义(P>0.05)。WT1基因阳性和阴性患儿诱导化疗后完全缓解率和复发率比较差异无统计学意义[87.69%(114/130)比86.79%(46/53)和16.15%(21/130)比18.87%(10/53),P>0.05]。截至随访结束,随访到179例患儿的生存状态,WT1基因阳性患儿生存率与WT1基因阴性患儿比较差异无统计学意义[89.68%(113/126)比86.79%(46/53),P>0.05];WT1基因阳性患儿中复发21例,复发患儿WT1基因水平完全缓解后与初诊时及复发后与初诊时比较差异无统计学意义(P>0.05),无复发患儿(96例完成检测)完全缓解后WT1基因水平明显低于初诊时[0.17%(0.04%,0.49%)比2.01%(0.41%,8.82%)],差异有统计学意义(P<0.01)。Kaplan-Meier生存曲线分析结果显示,WT1基因阳性患儿与WT1基因阴性患儿生存时间比较差异无统计学意义(P>0.05);根据WT1基因中位表达水平(1.41%)将WT1基因阳性患儿分成高表达(66例)和低表达(64例),WT1基因低表达患儿与WT1基因高表达患儿生存时间比较差异无统计学意义(P>0.05)。结论 WT1基因在ALL患儿中普遍表达,与患儿的某些临床特征及预后相关。WT1基因表达水平降低可能预后更好。Objective To investigate the expression of WT1 gene in children with acute lymphoblastic leukemia(ALL),and explore its clinical characteristics and correlation with the prognosis of ALL.Methods The clinical data of 183 children with newly diagnosed ALL in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2015 to May 2019 were retrospectively analyzed.The expression level of WT1 gene in bone marrow samples was detected by real-time fluorescence quantitative polymerase chain reaction.The children were followed up to June 2021 with a median follow-up time of 46 months(0 to 63 months).Results Among 183 children with ALL,the WT1 gene positive was in 130 cases(71.04%),and the expression level was 1.41%(0.26%,6.73%);WT1 gene negative was in 53 cases(28.96%).The expression levels of WT1 gene in children with T-cell lymphoblastic leukemia(T-ALL),non-hyperdiploid and middle/high-risk were significantly increased,and there were statistical differences(P<0.05 or<0.01);however,there were no statistical differences in the expression levels of WT1 gene between children with different gender,chromosome karyotype,hepatosplenomegaly and the first diagnosis white blood cell count(P>0.05).There were no statistical differences in complete remission rate and recurrence rate after induction chemotherapy between WT1 gene positive children and WT1 gene negative children:87.69%(114/130)vs.86.79%(46/53)and 16.15%(21/130)vs.18.87%(10/53),P>0.05.By the end of follow-up,179 children were followed up,and there was no statistical difference in survival rate between WT1 gene positive children and WT1 gene negative children:89.68%(113/126)vs.86.79%(46/53),P>0.05.Among the children with WT1 gene positive,relapse was in 21 cases,and there was no statistical difference in the expression level of WT1 gene after complete remission or after relapse,compared with that while the first diagnosis(P>0.05);among non-relapse children,96 completed the detection,the expression level of WT1 gene after complete remi

关 键 词：白血病 淋巴细胞 儿童 预后 WT1基因 

分 类 号：R733.71[医药卫生—肿瘤]