摘要
探索应用ＴＣＲｒ基因重排标志及改良的极限稀释定量ＰＣＲ法检测小儿ＡＬＬ微小残留病（ＭＲＤ）的可行性，探讨其追踪骨髓ＭＲＤ变化的临床意义。方法：改良极限稀释定量ＰＬＲ法。结果：敏感度平均为４拷贝。对１４例初治阳性病人在诱导达到缓解（ＣＲ）时的ＭＲＤ定量检测结果显示，骨髓复发组ＭＲＤ定量值平均为０．３４３％，未复发组为０．００４％（Ｐ＜０．０１）。１４例中６例ＣＲ时ＭＲＤ阴性，４例在追踪期内持续阴性，２例转为阳性（分别为０．０１７％、０．０２０％），化疗后ＭＲＤ渐减少至转阴；３例ＣＲ时ＭＲＤ平均值为０．０７７％，在缓解期ＭＲＤ值渐减少，其中２例临床持续缓解，１例骨髓无复发但发生睾丸白血病，１例ＣＲ时ＭＲＤ值较高，２例持续高值，２例ＭＲＤ值渐增高，此５例均复发。结论：ＣＲ时ＭＲＤ阳性的病人应持续监测其水平，若持续高值或逐渐增高，复发的可能性大，应加强化疗以防复发。采用极限稀释定量法检测ＡＬＬ的ＭＲＤ有简单、敏感性高的优点。
To explore the feasibility of detecting minimal residual disease (MRD) inchildren with ALL using TCRr gene rearrangements as markers and modified limiting dilution PCR assay. To probe preliminarily into the clinical significance of limiting dilution quantitative PCR in following up the MRD changes. Methods Using modified limiting dilution assay. Results: The average sensitivity was 4 copy. MRD cells were quantitated at inductioncomplete remission (CR)in 14 cases whose untreated samples were positive. The averageamount of MRD cells was 0. 343% in marrow relapse group and 0. 004% in non-relapsegroup (P<0. 01). of 14 cases, 6 were negative MRD at CR,4 Kept negative during following-up and 2 turned to positive (0. 017% 0. 020% respectively). After strong consolidationtherapy, MRD decreased to negativel in 3 cases, the mean level of MRD was 0. 077% atCR. During remission period,MRD levels decreased gradually, 2 were in clinical continuousremission, 1 had testicular leukemia but not BM relapsel MRD level of1 case was high atCR, 2 were persistant high and 2 increased gradually,these 5 cases all relapsed. Conclusion:To patients with MRD positive at CR, the MRD level should be monitored continually; ifMRD level was persistently highor increased gradually, the possibility of relapse was comparatively high and strengthened chemotherapy should be given to prevent relapse. Themethod of limiting dilution quantitative assay has the advantages of simple, effectiveness andhigh sensitivity in detecting MRD in ALL.
出处
《中国小儿血液》
1999年第1期5-8,共4页
China Child Blood
