柔红霉素(DNR)荧光直方图诊断白血病细胞耐药的意义(英文)

Significance of fluorescent histogram of daunorubicin(DNR) in diagnosis of drug resistance to leukemic cells

目的：建立检测细胞内柔红霉素（ＤＮＲ）的荧光直方图诊断白血病细胞耐药的方法。材料与方法：选取１５例临床耐药的急性髓性白血病（ＡＭＬ），５例初治ＡＭＬ进行研究，用流式细胞仪（ＦＣＭ）检测细胞内ＤＮＲ的荧光强度，根据其强弱程度划分成耐药区和药敏区，其直方图主峰左移（ＬＳＭＰ）诊断为耐药；直方图右移（ＲＳＭＰ）诊断为药敏。耐药指数（ＤＲＩ），即Ｒ／Ｓ（Ｒ为耐药细胞数，Ｓ为药敏细胞数）≥２为耐药，＜２为药敏。荧光指数（ＦＩ）＝平均荧光强度×ＤＲＩ，ＦＩ≥２００为耐药，ＦＩ＜２００为药敏。结果：初治５例ＡＭＬ中，４例为ＲＳＭＰ，ＤＲＩ＝０２３～１１３，ＦＩ＝５０～１６０，诊断为药敏；另一例为ＬＳＭＰ，ＲＩ＝３６０，ＦＩ＝３６７，诊断为原发耐药。１５例临床耐药的ＡＭＬ中，１２例为ＬＳＭＰ，ＤＲＩ＝２５９～１７７２，ＦＩ＝２６５～１０４１，诊断为经典耐药；其余３例为ＲＳＭＰ，ＤＲＩ＝０３９～０６７，ＦＩ＝５７～８３，诊断为再生耐药。结论：用ＦＣＭ检测白血病细胞内ＤＮＲ的荧光直方图，结合ＤＲＩ、ＦＩ以及临床耐药表现和耐药细胞荧光强度的诊断界点的方法，我们可以快速、简便、直观地在临床上及时发现和评价ＡＭＬ耐药的?

Objective: To develop a fluorescent histogram of intracellular daunorubicin(DNR) as a diagnostic method for drug resistance in acute myeloid leukemia(AML). Methods: 15 patients with clinically diagnosed drugresistant AML and 5 patients with previously untreated AML were studied. The intensity of fluorescence of intracellular DNR and the fluorescent histogram were determined by flow cytometer(FCM).According to a degree of the intensity, both drugresistant andsensitive zones were marked off. Left shift of main peak(LSMP) with the fluoresent histogram may be diagnosed as drug resistance, and right shift of main peak(RSMP) as drug sensitivity. R/S stood for drug resistant index(DRI);R for the number of drugresistant cells, and S for drugsensitive cells. DRI2 was drugresistant or DRI< 2 was drugsensitive. Fluorescent index(FI) was the product of mean fluorescent intensity (MFI) multiplied by DRI. FI200 meant drugresistant, while FI< 200 meant drugsensitive. Results: Among 5 patients with previously untreated AML, 4 patients were diagnosed as drugsensitive for RSMP, DRI=023113,FI=50160,and one patient was diagnosed as primary drugresistant for LSMP,DRI=360, FI=367 In 15 patients with clinically drugresistant AML,12 patients were diagnosed as classical resistance for LSMP,DRI=2591772,and FI=2651041,and 3 patients as regrowth drug resistance for RSMP,DRI=039067,and FI=5783 Conclusion: Clinically, it was a rapid, convenient and visual way, which by FCM mapping the fluorescent histogram of intracellular DNR, in combination with DRI, FI, a clinically drugresistant manifestation and a cutoff point for diagnosis of the fluorescent intensity of drugresistant cells, we may in good time find and value a type and a degree of drug resistance to AML. Moreover ,it may provide a basis for working out an individually therapeutic scheme and a method for an observation in drugresistant reversal treatment as well.