上皮型钙黏蛋白在髓外白血病患者骨髓单个核细胞表面及血浆中的表达及其临床意义

Expression of E-cadherin on bone marrow mononuclear cell surface and in plasma of patients with extra-myeloid leukemia and their clinical significance

目的：探讨急性白血病（AL）患者骨髓单个核细胞（MNC）表面上皮型钙黏蛋白（E-cad）及血浆中可溶性 E-cad（sE-cad）的表达在髓外白血病发生、发展和疗效判定中的临床意义。方法初治或复发的 AL 患者87例（L119例，L229例，M214例 M320例，M44例，M51例）均为哈尔滨医科大学附属肿瘤医院血液内科住院患者；对照组血浆来自20名健康志愿者，对照组骨髓来自血液科15例非 AL 的住院患者（血小板减少性紫癜7例，缺铁性贫血4例，发热4例）。应用酶联免疫吸附测定（ELISA）检测47例AL 患者及20名健康志愿者血浆中 sE-cad 的表达；应用流式细胞术检测40例 AL 患者及15例对照者骨髓 MNC 表面 E-cad 的表达。结果 AL 组血浆中 sE-cad 的表达水平为（66.812±52.712） ng／ml，高于健康对照组的（17.976±14.206） ng／ml （P＜0.01）。 AL 患者中，髓外浸润组血浆 sE-cad 的表达水平为（83.545±60.759） ng／ml，高于非髓外浸润组的（42.152±22.043） ng／ml（P＜0.01）；高白细胞血症组血浆 sE-cad 的表达水平为（85.166±57.828）ng／ml，高于非高白细胞血症组的（41.933±32.064）ng／ml （P＜0.05）。 AL 组骨髓 MNC 表面 E-cad 的阳性比例为（13.615±14.038）%，低于对照组的（31.700±16.213）%（P＜0.01）。 AL 患者中，非髓外浸润组骨髓 MNC 表面 E-cad 阳性比例为（18.691±14.917）%，高于髓外浸润组的（6.589±8.959）%（P＜0.01）；非高白细胞血症组骨髓 MNC 表面 E-cad 阳性比例为（20.925±12.081）%，高于高白细胞血症组的（7.446±11.118）%（P＜0.01）。结论 AL 患者骨髓 MNC 表面E-cad 低表达及血浆中 sE-cad 高表达可能与髓外白血病及高白细胞血症的发生相关，可能是白血病细胞发生髓外浸润的重要分子病理机制之一。 AL 患者血浆中 sE-cad 高表达可作为髓外白血病的诊断指标之一。

Objective To investigate the expression and clinical significance of soluble E-cadherin （sE-cad） and E-cadherin （E-cad） in acute leukemia （AL）, and to explore their relationship with the pathogenesis,development and diagnosis of extra-myeloid leukemia. Methods 87 newly diagnosed or relapsed AL patients （19 cases of L1, 29 L2, 14 M2, 20 M3, 4 M4, 1 M5） were collected from hospitalized patients in hematology department of Harbin Medical University Cancer Hospital. The plasma from 20 healthy volunteers was used as control group. The bone marrow was from 15 non-AL patients hospitalized in hematology department （7 cases of thrombocytopenic purpura, 4 iron deficiency anemia, and 4 fever）. The expression of sE-cad in the plasma of 47 patients and 20 healthy volunteers was detected by ELISA; the expression of E-cad on the membrane surface of bone marrow MNC in 40 patients and 15 controls was determined by flow＆amp;nbsp;cytometry. Results The plasma level of sE-cad in AL group was significantly higher than that in healthy control group [（66.812±52.712） ng/ml vs. （17.976±14.206） ng/ml, P〈0.01]. The plasma level of sE-cad in extra-myeloid infiltration AL group was significantly higher than that in no-extra-myeloid infiltration AL group [（83.545±60.759） ng/ml vs. （42.152±22.043） ng/ml, P〈0.01]. The plasma level of sE-cad in high leukocytes AL group was higher than that in no-high leukocytes AL group [（85.166±57.828） ng/ml vs. （41.933±32.064） ng/ml, P〈0.05]. The percentage of E-cad expression in AL group was significantly lower than that in control group [（13.615±14.038） % vs. （31.700±16.213） %, P〈0.01]. The percentage of E-cad expression in no-extra-myeloid infiltration AL group was significantly higher than that in extra-myeloid leukemia infiltration AL group[（18.691±14.917） % vs. （6.589±8.959） %,P〈0.01]. The percentage of E-cad in no-high-leukocytes AL group was significantly higher in high leukocytes AL group [（20.925±12.081） % vs. （7.446±11.118） %, P〈0.01]. Conclusions The expression of E-cad on the membrane surface of bone marrow MNC and the expression of sE-cad in plasma may be closely associated with the occurrence of extra-myeloid leukemia and leukocytosis, which may be one of the important molecular mechanisms of leukemic cell infiltration and leukocytosis. High expression of sE-cad in plasma can be treated as one of index to diagnose extra-myeloid leukemia.