CDX2基因在成人急性髓细胞白血病中的表达及临床意义

Expression and clinical significance of CDX2 gene in adult acute myeloid leukemia

目的 研究尾型同源盒基因2（CDX2）在急性髓细胞白血病（AML）患者中的表达及临床意义。方法 通过RTPCR方法检测114例初发AML患者及56例诱导化疗后患者骨髓和（或）外周静脉血单个核细胞CDX2基因表达,19例随访患者每3个月定期检测CDX2基因表达。8名健康者外周静脉血和5名缺铁性贫血患者骨髓作为对照。结果 114例AML患者和13名对照的骨髓和（或）外周血单个核细胞均检测到CDX2基因表达。以第一个四分位数为界划分低表达组和高表达组,对照组CDX2基因表达水平均在低表达组,114例AML患者高表达组90例（78.9%）,对照组与AML患者CDX2基因表达差异有统计学意义（P〈0.01）。初发患者骨髓和外周静脉血CDX2基因表达呈正相关（r=0.656,P〈0.01）。CDX2高低表达组诱导化疗完全缓解（CR）率差异无统计学意义（P〉0.05）。本组AML病例CDX2高表达78.9%。CR患者CDX2表达量为化疗前的10.3%-86.2%,且随着疗程增加逐步降低,复发时显著升高。随访6个月以上病例19例,两组早期复发率差异无统计学意义（P〉0.05）。结论 CDX2表达量变化反映患者体内白血病细胞负荷,持续高表达可能是预后不良指标之一,可作为染色体核型正常AML微小残留病监测指标。

Objective To explore the expression and clinical significance of caudal homeobox gene CDX2 in acute myeloid leukemia（AML）patients.Methods Bone marrow（BM）and peripheral blood（PB）samples were colleted in 114 cases of donor AML patients and 56 patients undergoing chemotherapy.The CDX2 gene expression in every patient′s mononuclera cells were detected by RT-PCR.Among these patients,19 cases were detected the gene continuous every three months.Eight healthy PB and five patients with iron deficiency anemia BM as control.Results CDX2 gene transcript levels were detectable in bone marrow mononuclear cells from 114 AML patients and 13 healthy donors,but the level of gene expression was higher in AML patients（90/114,78.9%）.There was a statistically significant difference between the AML patients and normal donor（P〈0.01）.The higher or lower expression of CDX2 gene showed no correlation with CR rate.CDX2 gene expression level had a positive correlation in BM and PB mononuclera cells（the correlation coefficient r=0.656,P〈0.01）.The expression of CDX2 in patients with CR was10.3%-86.2% of pre-chemotherapy,wihch decreased with the treatment course,while elevated in recurrence.19 cases of patients underwent half a year of follow-up,there was no significant difference of the rate of early recurrence in two groups（P〉0.05）.Conclusion Higher expression level of CDX2 gene is mostly in AML patients,but its expression has no relation with CR rate.CDX2 gene may be a prognostic molecular marker in AML patients,and can be used to monitor the minimal residual disease of Normal chromosome karyotype AML.