CD38及ZETA相关蛋白在慢性淋巴细胞白血病中的表达及其临床意义

Expression of CD38 and ZAP.70 in chronic lymphocytic leukemia patients and their clinical significance

目的探讨CD38及ZETA相关蛋白（ZAP-70）在慢性淋巴细胞白血病（CLL）患者中的表达及其与临床分期的关系，分析其对预后的影响。方法采用流式细胞术检测42例CLL患者CD38及ZAP-70的表达水平，根据Rai分期将患者分为高危组（III、Ⅳ期）（25例）和低中危组（0、I、Ⅱ期）（17例），了解CD38和ZAP-70表达在Rai分期的分布情况，结合患者病情进展、化疗疗效进行分析。结果CLL患者中CD38＋者占47．6％（20／42），其中高危组64．0％（16／25），低中危组23．5％（4／17），两组差异有统计学意义（x2=6．645，P=0．014）；ZAP-70＋者占40．5％（17／42），其中高危组60．0％（15／25），低中危组11．8％（2／17），两组差异有统计学意义（X2=9．772，P=0．003）；ZAP-70＋CD38＋和ZAP-70＋CD38-患者多分布在高危组中，而ZAP-70-CD38-患者多分布在低中危组中，差异均有统计学意义（x2=10．076、9．346、6．005，均P〈0．05）。随访48个月（1～136个月）后ZAP-70＋CD38＋及ZAP-70-CD38-患者无进展生存期分别为19．0和58．0个月，差异有统计学意义（x2=11．488，P=0．003），而ZAP-70＋CD38-和ZAP-70-CD38患者无进展生存时间分别为43．5和51．7个月，差异无统计学意义（x2=0．075，P：0．784）。结论CD38和ZAP．70在CLL病程后期（Rai分期Ⅲ期和Ⅳ期）表达高于病程早期（Rai分期0期、I期和Ⅱ期），CD38和ZAP-70均阳性CLL患者较单阳性患者病情进展快，生存期明显缩短。

Objective To investigate the expression of CD38 and ZAP-70 in chronic lymphocytic leukemia and the relationship between the clinical stages and prognostic significance. Methods Flow cytometry was used to analyze CD38 and ZAP-70 expression in CLL, the patients were divided into high-risk group （III, IV stage） （25 cases） and low-medivm risk group （0, I, II stage） （17 cases） according to Rai clinical stages. The distribution of CD38 and ZAP-70 expression in Rai clinical stages and the prognostic significance were analyzed. Results Positive expression of CD3s was 47.6 % （20/42） in all patients, 64.0 % （16/25） patients in high-risk group and 23.5 % （4/17） in low-medium risk group. The distribution of CD38 expression had significant difference between two groups （X2 = 6.645, P = 0.014）. Positive expression of ZAP-70 was 40.5 % （17/42） in all patients, 60.0 % （15/25） patients in high-risk group and 11.8 % （2/17） in low-medium risk group. The distribution of ZAP-70 expression had significant difference between two groups （ X2 = 9.772, P = 0.003）. The patients with ZAP-70＋ CD38 and ZAP-70＋ CD38- were more distribute in high risk campare to the CD;8 ZAP-70- in low-medium risk group （X2=10.076, 9.346, 6.005, all P 〈 0.05）. Follow-up 48 months （1-136 months）, the progression-free survival of patients with ZAP-70＋ CD38 and ZAP-70- CD38 were respectively for 19.0 and 58.0 months （X2 = 11.488, P = 0.003）. The progression-free survival of ZAP-70＋ CD3s or ZAP-70- CD38＋ were 43.5 and 51.7 months and not statistically significant （X2 = 0.075, P = 0.784）. Conclusion CD38 and ZAP-70 positive expression occurs in large proportion of CLL patients with advanced stages （Rai III and IV stage） and according to the clinical stages the expression of CD38 and ZAP-70 may be predicted. The current findings suggest that both ZAP-70 and CD38 expression should be assessed in patients with CLL for the definition of prognostic subgroups.