急性白血病缓解前后HLA分子血清学分型和分子生物学分型的比较

Comparison of HLA serological typing and molecular typing in acute leukemia between pre- and post complete remission

目的比较急性白血病（AL）患者缓解前后HIA血清学分型以及分子生物学分型的结果。以确定能否在缓解前进行HLA配型。方法对20例AL患者缓解前后外周血标本分别应用微量淋巴细胞毒（CDC）和序列特异性引物聚合酶链反应技术（PCR—SSP）进行HLA血清学和分子生物学分型。对HLAⅠ类分子CDC反应强度进行NIH计分，进行缓解前后配对t检验；对缓解前后HLAⅠ、Ⅱ类分子等位基因特异性进行比较。结果缓解前后所有病例HLAⅠ、Ⅱ类分子等位基因特异性均未出现缺失或改变。缓解前后HLA～A、B基因座位抗原及Bw6超型的CDC反应强度差异有统计学意义（P〈0．05），缓解前表达明显下调；Bw4超型在缓解前后的CDC反应强度差异无统计学意义（P〉0．05）。HLAⅠ类分子表达下调或缺失与外周血幼稚细胞含量无明显相关性。结论对AL患者，可以在确定诊断时即进行HLA的分子生物学分型，从而缩短配型时间，增加寻找合适供者的机会。

Objective To compare the results of HLA serological typing and gene typing in acute leukemia before and after achieved complete remission, then make sure whether the HLA matching could be performed before remission of acute leukemia. Methods The peripheral blood samples of 20 patients with acute leukemia at onset and in complete remission were performed for the HLA serological typing and gene typing by complement-dependent microcytotoxicity （CDC） assay and PCR-sequence for specific primer. The class Ⅰ HLA antigens reaction was quoted as NIH score, and paired-sample t test was performed. The class I and class Ⅱ HLA allele specificity of acute leukemia at onset was compared with that in complete remission. Results No absence or change of the class Ⅰ and class Ⅱ HLA allele specificity in acute leukemia was observed before treatment and after complete remission. There were significant differences （P 〈0.05） for HLA- A, B and Bw6 reaction at onset from complete remission. The expression of HLA-A, B and Bw6 was significant down-regulated. This phenomenon did not occur on Bw4 （P 〉0.05）. The relationship of downregulation of class Ⅰ HLA antigens and the amount of blast in peripheral blood was not observed. Conclusion HLA typing could be performed by molecular technique when patients with acute leukemia were diagnosed. It would shorten the period of HLA-matching, and increase the opportunity of finding an appropriate allergenic hematopoietic stem cell donor.