白血病患者WT1基因的表达及其与预后及多药耐药的关系

WT1 gene expression in leukemia patients and its correlation with prognosis and multidrug resistance

目的探讨ＷＴ１基因与白血病的预后、多药耐药性及细胞凋亡之间的关系。方法应用逆转录聚合酶链反应（ＲＴＰＣＲ）方法测定６８例白血病患者及２３名正常人的ＷＴ１、ＭＲＰ及ｍｄｒ１基因的表达，同时采用免疫荧光流式细胞术（ＦＣＭ）观察了３２例急性髓系白血病（ＡＭＬ）患者抗凋亡基因ｂｃｌ２的表达。结果６８例白血病患者中３７例ＷＴ１基因表达阳性，２３名正常人ＷＴ１基因表达阴性。ＷＴ１基因表达阳性患者的完全缓解（ＣＲ）率低于表达阴性者（分别为５９．４６％和８７．１０％，Ｐ＝００１１）。ＷＴ１表达阳性患者的ＭＲＰ阳性率高于ＷＴ１表达阴性者（分别为５８．３３％和３２．２６％，Ｐ＝００３３）。联合ＷＴ１及ｂｃｌ２表达情况将ＡＭＬ患者分为高危、中危、低危三组，其ＣＲ率分别为３３３３％、４７．３７％及１００％，三组间差异有显著性（Ｐ＜０．０５）。结论ＷＴ１基因的表达与白血病患者的化疗效果及预后密切相关，是影响白血病患者ＣＲ率的重要危险因素之一。

Objective To evaluate the value of expression of WT1 gene in predicting the prognosis of leukemia patients, and explore the relationship between WT1 gene expression and multidrug resistance and cell apoptosis. Methods Expressions of WT1, MRP and mdr1 were measured in 68 leukemia patients by RT PCR method. Expression of bcl 2 was measured in 32 AML patients by immunofluorescence flow cytometry. Results Expression of WT1 was revealed in 36 of 68 leukemia patients and none of 23 normal controls. Complete remission rate (59.46%) was lower in WT1 positive patients than that (87.10%,P=0 011) in WT1 negative patients. The rate of MRP expression was also higher in patients with WT1 expression (58.33%) than in those without WT1 expression (32.26%,P=0.033).Thirty two AML patients were divided into high , intermediate , and low risk groups according to the expression of WT1 and bcl 2. CR rates were significantly different among these 3 groups (33.33% for high , 47.37% for intermediate , and 100% for low risk group, P<0.05). Conclusion The expression of WT1 can predict the treatment outcome and the prognosis for leukemia patients. Expression of WT1 is the most important risk factor, and the coexpression of WT1 and bcl 2 predicts poor prognosis of AML patients.