急性髓系白血病患者血浆循环DNA动态监测及其临床意义

Dynamic Monitoring of Plasma Circulating DNA in Patients with Acute Myeloid Leukemia and Its Clinical Significance

本研究旨在动态监测急性髓系白血病(AML)患者血浆循环DNA的含量,探讨其临床意义。采集66例AML患者不同临床状态的静脉血,以60例体检健康者、20例良性血液病患者、20例实体肿瘤患者为对照,用磁珠法提取血浆标本中循环DNA和内参照质粒DNA,双重荧光定量PCR技术进行DNA定量检测。结果表明:AML患者诊断时血浆DNA含量为168.5(73.4-245.1)ng/ml,显著高于各对照组,男性患者血浆DNA含量显著高于女性患者(P=0.019),不同年龄、不同FAB型别的患者间血浆DNA含量无统计学差异。化疗后血浆DNA水平显著低于化疗前,完全缓解、部分缓解组患者血浆DNA水平与健康对照组已无显著差异,但与未缓解组有显著性差异(P<0.05)。缓解后复发的6例患者中有5例(83.3%)复发时血浆DNA水平明显升高,未复发的25例患者中有22例(88.0%)血浆DNA水平保持稳定。结论:血浆DNA定量检测对AML的化疗疗效判断及复发监测具有重要意义。

This study was aimed to quantify plasma circulating DNA level in patients with acute myeloid leukemia （AML） and to evaluate its clinical significance. 66 AML patients and 100 controls （60 healthy subjects for health examination, 20 cases of benign hematopathy, and 20 cases of solid tumors） were enrolled in this study. Blood samples were collected from AML patients at different status of disease and control groups. Circulating DNA were drew by using the BILATEST DNA Kit. The level of plasma DNA was determined by using duplex real-time quantitative PCR. The results showed that the median value of plasma DNA level in AML patients at diagnosis was 168.5 （73.4 -245.1 ） ng/ml, significantly higher than those in three control groups, and the median level in male patients was significantly higher than that in female patients （ P =0. 019）. No significant difference was found in plasma DNA level of the patients at different ages and with different FAB subtypes. Compared with level before chemotherapy, the plasma DNA levels in complete remission patietns and partial remission patients decreased significantly, and with no statistical difference from level of healthy controls, but was significantly different from level of non-remission patients （ P 〈 0.05）. Following up of 31 remission patients showed that the plasma DNA level increased in 5 out of 6 （83.3%） relapsed patients, but no increase was found in 22 out of 25 （88.0%） non-relapsed patients. It is concluded that the quantification of plasma DNA may be useful for evaluating therapeutic effects and monitoring relapse in AML patients.