急性髓系白血病MDR1和BAALC基因表达水平及其预后意义的探讨

Simultaneous detection of MDR1 and BAALC gene expression in acute myeloid leukemias and its clinical implication

目的:探讨联合检测初治急性髓系白血病(AML)组织多药耐药基因1(MDR1)及脑和急性白血病胞质(BAALC)的表达量以及在预后判断中的作用。方法:荧光定量PCR检测并分析160例初治AML组织MDR1和BAALC基因的表达量及其与临床疗效和预后的关系。结果:初治AML组织MDR1和BAALC基因表达水平呈正相关性,P<0.001。MDR1高表达的AML患者同低表达组相比完全缓解(CR)率低,复发率高,总生存率低,P值均<0.05;而BAALC高低表达的差异均无统计学意义。MDR1和BAALC均低表达组疗效及预后最好,均高表达组最差。MDR1和BAALC均低表达组和MDR1低表达且BAALC高表达组的CR率均显著高于均高表达组,P值分别为0.004和0.034;前2组复发率(21.6%和25.9%)也显著低于后者(56.0%),P值分别为0.006和0.029;而均低表达组总生存率(62.2%)也显著高于均高表达组(28.3%)和MDR1高表达且BAALC低表达组(38.2%),P值分别为0.002和0.048。结论:MDR1高表达对初治AML患者的预后意义高于BAALC基因,只要检测到MDR1基因的高表达,无论BAALC高表达或者低表达,均提示较差的预后。联合检测初治AML患者MDR1和BAALC基因表达水平可进一步提高预测价值。

OBJECTIVE： To simultaneous detecte MDR1 and BAALC gene expressionsl in adult patients with AML patients and investigated its prognostic implications. METHODS： The MDR1 and BAALC expressions were detected by real-time fluorescent quantitative polymerase chain reaction （RQ-PCR） in 160 adult AML patients. RESULTS： There was a correlation between the expression of MDR1 and BAALC gene expression （P^0. 001）in adult AML patients. There was a significant difference of CR rate,the cumulative relapse rates and survival curve between the high MDR1 expression group and the low MDR1 expression group （P^0. 05）, but not as BAALC ex- pression. Combined detection of MDR1 and BAALC gene ex- pression showsed：low MDR1/low BAALC group had the best prognosis and high MDR1/high BAALC group had the worst prognosis. Low MDR1/low BAALC group and low MDR1/ high BAALC group had a significantly higher CR rate,P valueswere 0. 004 and 0. 034） and lower cumulative relapse rate （21.6% and 25.9% vs 56.0%,P were 0. 006 and 0. 029）compared with high MDR1/high BAALC group. Low MDR1/low BAALC group had a longer OS （62.2%） compared with high MDR1/high BAALC （28.3% ,P=0. 002） and high MDR1/Iow BAALC expression group （38.2%, P = 0. 048）. CONCLU- SIONS： High expression of MDR1 is a more important risk fac tor than high expression of BAALC for predicting a poor prog- nosis in de novo adult AML patients. Simultaneous detection of MDR1 and BAALC gene expressions is more effective to the judgement of prognosis in AML.