不同海拔急性髓系白血病患者化疗前后血清及骨髓造血因子表达水平差异研究  

Differences in Expression Levels of Haemopoietic Factors in Serum and Bone Marrow before and after Chemotherapy in Patients with Acute Myeloid Leukemia at Different Altitudes and Their Significance

作　　者：孙琦 周厚法 李文倩[3] 解友邦[3] 王爱博 SUN Qi;ZHOU Houfa;LI Wenqian;XIE Youbang;WANG Aibo(Graduate School of Qinghai University,Xining 810016,China;Department of Gastroenterology,Zaozhuang Municipal Hospital,Zaozhuang 277000,China;Department of Hematology,Qinghai Provincial People's Hospital,Xining 810000,China)

机构地区：[1]青海大学研究生院,青海省西宁市810016 [2]山东省枣庄市立医院消化科,277000 [3]青海省人民医院血液科,青海省西宁市810000

出　　处：《中国全科医学》2024年第14期1716-1722,共7页Chinese General Practice

基　　金：国家血液系统疾病临床医学研究中心转化研究课题(2021WWB04);青海省血液系统疾病临床研究中心项目(2021-SF-136)。

摘　　要：背景化疗是急性髓系白血病(AML)患者重要的治疗手段,最常见的毒副作用是骨髓抑制。各类血细胞的发育增殖、分化受到多种造血因子的调控,不同海拔AML患者化疗后造血因子表达水平是否存在差异及其变化规律尚未明确。目的探讨不同海拔AML患者化疗前后骨髓及血清造血因子表达水平是否存在差异及其变化。方法选取2021—2022年青海省人民医院血液科(中海拔地区1501~2500 m)及中国人民解放军空军军医大学西京医院血液科(低海拔地区500~1500 m)首诊初治的28例AML患者(非M3型)为研究对象,根据就诊医院海拔高低将AML患者分为中海拔组(13例)和低海拔组(15例)。采用WHO抗癌药物急性及亚急性毒性反应分级标准评估患者化疗第8、14、28天骨髓抑制分度;采用酶联免疫吸附法对两组患者化疗前、化疗第8天、化疗第28天血清及骨髓促红细胞生成素(EPO)、FMS样酪氨酸激酶3配体(Flt3-L)、促血小板生成素(TPO)和干扰素γ(IFN-γ)表达水平进行检测并比较。结果化疗第14、28天,低海拔组患者骨髓抑制分度均高于中海拔组(Z=-1.975,P=0.048;Z=-2.049,P=0.040)。化疗第28天,低海拔组血清及骨髓EPO表达水平高于中海拔组(P<0.05);中海拔组化疗第28天血清EPO表达水平低于化疗第8天(P<0.05)。化疗第28天,低海拔组血清及骨髓Flt3-L表达水平均高于中海拔组(P<0.05);两组患者化疗第8天、化疗第28天血清Flt3-L表达水平均高于化疗前,两组患者化疗第28天骨髓Flt3-L表达水平均高于化疗前(P<0.05)。化疗前、化疗第8天、化疗第28天,低海拔组血清TPO表达水平均高于中海拔组(P<0.05);低海拔组患者化疗第8天血清TPO表达水平低于化疗前(P<0.05);化疗第28天,低海拔组骨髓TPO表达水平高于中海拔组(P<0.05);中海拔组化疗第28天骨髓TPO表达水平低于化疗前(P<0.05)。两组患者化疗前后血清及骨髓IFN-γ表达水平组间、组内比较,差异�Background Chemotherapy is a crucial treatment for patients with acute myeloid leukemia(AML),with bone marrow suppression as the most common toxic side effect.The development,proliferation,and differentiation of various types of blood cells are regulated by a variety of hematopoietic factors.However,it is not clear whether there is a difference in the expression level of hematopoietic factors after chemotherapy in patients with AML at different altitudes and the change pattern has not been clarified.Objective To investigate whether there are differences in the expression levels of hematopoietic factors in bone marrow and serum before and after chemotherapy and their changes in patients with AML at varying altitudes.Methods A total of 28 AML patients(non-M3 type)treated for the first time in the Department of Hematology at Qinghai Provincial People's Hospital(1501 to 2500 m in the middle altitude area)and the Department of Hematology of Xi-Jing Hospital,Air Force Medical University of PLA(500 to 1500 m in low altitude area)from 2021 to 2022 were selected as the research subjects,and according to the altitude of the hospitals they visited,the AML patients were divided into the middle altitude group(13 cases)and the low altitude group(15 cases).The WHO grading criteria for acute and subacute toxicity of anticancer drugs was used to evaluate the myelosuppressive scores of the patients on days 8,14,and 28 of chemotherapy.The expression levels of erythropoietin(EPO),FMS-like tyrosine kinase 3 ligand(Flt3-L),thrombopoietin(TPO),and interferonγ(IFN-γ)in serum and bone marrow before chemotherapy and on day 8,day 28 of chemotherapy were detected and compared by enzyme-linked immunosorbent assay.Results On days 14 and 28 of chemotherapy,the myelosuppressive scores of patients in the low-altitude group were higher than those in the middle-altitude group(Z=-1.975,P=0.048;Z=-2.049,P=0.040).On day 28 of chemotherapy,the serum and bone marrow EPO expression levels in the low-altitude group were higher than those in the middle-

关 键 词：白血病 急性髓系白血病 海拔 造血细胞生长因子 促红细胞生成素 FMS样酪氨酸激酶3配体 促血小板生成素 干扰素γ 

分 类 号：R733.73[医药卫生—肿瘤]