CD38ZAP-70在B慢性淋巴细胞白血病中表达及其临床意义的研究

Expression of CD38 and ZAP-70 in B-Cell Chronic Lymphocytic Leukemia

目的:检测CD38及zeta链相关蛋白-70(zeta-associated protein-70,ZAP-70)在B慢性淋巴细胞白血病(B-CLL)中的表达,探讨其与临床的相关性。方法:采用流式细胞仪检测51例B慢性淋巴细胞白血病(B-CLL)患者骨髓或外周血白血病细胞CD38和ZAP-70的表达,结合其与患者临床分期、病情进展、化疗疗效进行分析。结果:1)44例患者中10例(22.73%)CD38和ZAP-70同时表达阳性,22例(50%)CD38和ZAP-70同时表达阴性。2)31例CD38患者中,初诊时处于Binet B+C期者9例(29.03%);11例CD38+患者中,初诊时处于Binet B+C期者7例(63.64%)。CD38阳性、阴性表达在Binet分期上无显著差异(P>0.05)。27例ZAP-70-患者中,初诊时处于Binet B+C期者6例(占22.22%);16例ZAP-7+患者中,初诊时处于Binet B+C期者10例(62.5%)。ZAP-70阳性、阴性表达在Binet分期上有显著差异(P<O.05)。3)23例患者予氟达拉滨单药或联合CTX治疗,16例CD38表达者中,化疗有效(CR+PR)者11例(68.75%);7例CD38+表达者中,化疗有效者2例(14.29%)。11例ZAP-70-表达者中,化疗有效者9例(81.82%);9例ZAP-70+表达者中,化疗有效者1例(11.11%)。CD38和ZAP-70阳性、阴性的表达与化疗疗效有显著差异(P<0.05)。结论:1)B-CLL患者CD38的表达和ZAP-70的表达有关。2)B—CLL患者ZAP-70阳性、阴性的表达与Binet分期有关系,ZAP-70的阳性表达患者较阴性表达者的病情进展快。3)B-CLL患者CD38和ZAP-70的阳性表达者较阴性表达者的化疗疗效差,预后欠佳。采用流式细胞术检测ZAP-70的表达结合CD38可以作为慢性淋巴白血病的临床分型和预后判断的一个参考指标。

Objective： To explore the clinical significance of expression of the CD38 and ZAP-70 in B-cell chronic lymphocytic leukaemia （B-CLL）. Methods： The expressions of CD38 and ZAP-70 proteins in the bone marrow or peripheral blood of 51 patients with B-CLL were determined by flow cytometry. The results were analyzed according to clinical stage and curative effect. Results： CD38 and ZAP-70 were positively expressed in 10 of 44 B-CLL patients （22.73%） and were negative in 22 patients （50%）. Nine of 31 patients （29.03%） without CD38 expression were of Binet B＋C stage. Seven of 11 patients （63.64%） with CD38＋ expression were of Binet B＋C stage. No significant difference was found in the expression of CD38 between Binet A stage and Binet B＋C stage （P〉0.05）. Six of 27 patients （22.22%） without ZAP-70 expression were of Binet B＋C stage. Ten of 16 patients （62.5%） with ZAP-70＋ expression were of Binet B＋C stage. A significant difference was found in the expression of ZAP-70 between Binet A and Binet B＋C stage （P〈0.05）. Twenty-three patients received chemotherapeutics （fludarabine）. Eleven of the 16 （68.75%） patients without CD38 expression had better prognosis after chemotherapy while only 2 of the 7 （14.29%） patients with CD38＋ expression had curative effect. At the same time, 9 of the 11 （81.82%） patients with ZAP-70 expression had better prognosis, while only 1 of the 9 （11.11%） patients with ZAP-70 ＋ expression had curative effect. The expressions of CD38 and ZAP-70 were correlated with the curative effect of chemotherapy （P〈0.05）. Conclusion： CD38 is correlated with ZAP-70 in B-CLL patients. The expression of ZAP-70 was significantly different between Binet A and Binet B＋C and can lead to worse clinical manifestations. CD38 and ZAP-70 proteins can be used as auxiliary clinical indices to classify the phase and to evaluate the prognosis of B-CLL.