bcl-2和bax蛋白在儿童急性白血病表达及临床意义

Expression of bcl-2 and bax protein and clinical significance in children with acute leukemia

目的 检测儿童急性白血病（ＡＬ） 患儿ｂｃｌ－ ２ 及ｂａｘ 蛋白表达水平，探讨其在急性白血病发病机制中的作用及对临床化疗，预后估计的价值。方法 流式细胞仪测定白血病细胞ｂｃｌ－ ２／ｂａｘ 蛋白抗原。结果 ①４１ 例ＡＬ细胞均不同程度表达ｂｃｌ－ ２ 和ｂａｘ，ｂｃｌ－ ２ 阳性细胞率为５ ．５％ ～５２ ．４％ 。ｂａｘ 蛋白阳性率为４ ．８％ ～４２．７ ％ 。但在急性淋巴细胞白血病（ＡＬＬ） 和急性非淋巴细胞白血病（ＡＮＬＬ） 间无显著差异（ Ｐ＞ ０．０５） ；②ｂｃｌ－ ２ 高表达（ ≥２１ ％） 病例的白细胞计数，髓外浸润例数明显高于低表达组，差异具有显著性（ Ｐ＜０ ．０５）。ｂａｘ 蛋白表达阳性率则与此无关；③ｂｃｌ－２ 蛋白在未缓解组及复发难治组均高表达，与完全缓解组及初诊组相比，差异极为显著（Ｐ＜ ０．０１）。ｂａｘ 蛋白在上述四组中无明显差异；④随ｂｃｌ－ ２／ｂａｘ 蛋白比率增高，临床缓解率明显下降。ｂｃｌ－ ２／ｂａｘ 蛋白比值＜ １ ，完全缓解率（ＣＲ）４８ ％ ，ｂｃｌ－ ２／ｂａｘ 蛋白比值≥１ ，ＣＲ 率１９％ 。结论 急性白血病ｂｃｌ－ ２ 蛋白高表达者，化疗效果差，预后不良；ｂｃｌ－ ２／ｂａｘ 蛋白比率增高。

Objective To measure bcl-2 and bax protein expression and explore the clinical significance in children with acute leukemia (AL). Methods Bcl-2 and bax protein were detected with a specific monoclonal antibody and flow cytometry. Results ①All 41 AL patients showed bcl-2 and bax expression with various levels.The incidence of bcl-2 and bax protein positive was 5.5%～52.4% and 4.8%～42.7% respectively. It was not correlated with AL subtypes (P>0.05). ②The high bcl-2 level (≥21%) was associated with high white blood cell (WBC) count. ③ The bcl-2 protein level of the incomplete remission and relapse group was obviously higher than that of the complete remission and previously untreated group (P<0.01). ④ The complete remission rate in the patients with bcl-2/bax protein ratio <1 was higher than that in those with a ratio ≥1 (P<0.01). Conclusions Bcl-2 protein displays an overexpression in AL and it is correlated with the prognosis and therapy reaction.