GLUT3在成人急性淋巴细胞白血病中的表达及意义

Expression and clinical significance of GLUT3 in adult acute lymphoblastic leukemia

目的探讨葡萄糖转运蛋白-3(GLUT3)在成人急性淋巴细胞白血病(ALL)中的表达及其临床意义。方法选取2013年2月至2016年3月就诊的成人初诊ALL患者78例为ALL组,以40例非血液系统疾病患者为对照组。根据免疫分型检查、骨髓细胞学及分子生物学检查结果将ALL患者分为49例B系ALL(B-ALL),29例T系ALL(T-ALL);15例Ph阳性,63例Ph阴性。所有成人ALL患者均接受1个疗程治疗并根据其治疗效果分为完全缓解组(52例)与未完全缓解组(26例)。实时荧光定量聚合酶链反应(qRT-PCR)检测各组研究对象骨髓单个核细胞中GLUT3基因表达水平。收集成人ALL患者初诊时临床资料,根据GLUT3基因表达水平检测结果的平均值将其分为高表达组(48例)与低表达组(30例),比较分析GLUT3基因表达与ALL患者临床指标的关系。所有ALL患者均进行随访并统计总生存时间(OS)与无病生存时间(DFS)。采用COX回归模型分析影响成人ALL患者预后的相关因素。结果ALL组患者骨髓单个核细胞中GLUT3表达水平显著高于对照组(P<0.05),ALL不同分型B-ALL组、T-ALL组与Ph阳性组、Ph阴性组均显著高于对照组(P<0.05),完全缓解组显著低于未完全缓解组(P<0.05),但B-ALL与T-ALL比较差异无统计学意义(P>0.05),Ph阳性组与Ph阴性组比较差异无统计学意义(P>0.05);GLUT3表达水平与ALL患者年龄、WBC数目、血红蛋白、髓外侵犯明显相关(P<0.05);COX回归模型分析显示年龄、白血病髓外侵犯及GLUT3高表达是影响ALL患者OS与DFS的独立危险因素。结论GLUT3在成人ALL患者初诊及复发过程中均呈高表达,其表达水平变化可能与ALL治疗效果及患者预后有关。

Objective To investigate the expression and clinical significance of glucose transporter-3(GLUT3)in adult acute lymphoblastic leukemia(ALL).Methods Seventy-eight adults with newly diagnosed ALL who were treated in our hospital from February 2013 to March 2016 were selected as the ALL group,and 40 patients with non-hematological diseases as the control group.According to the results of immunophenotyping,bone marrow cytology and molecular biology,patients with ALL were divided into B-line ALL subgroup(B-ALL subgroup,n=49)and T-line ALL subgroup(T-ALL subgroup,n=29);15 cases of Ph-positive ALL and 63 cases of Ph-negative ALL.All adult ALL patients received a course of treatment and were divided into a complete remission group(n=52)and an incomplete remission group(n=26)according to their treatment effects.Real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)was used to detect the expression level of GLUT3 gene in bone marrow mononuclear cells of subjects in each group.The clinical data of adult ALL patients at the initial diagnosis were collected,and divided into high expression group(n=48)and low expression group(n=30)according to the average value of GLUT3 gene expression level by tests.The relationship between GLUT3 gene expression and the clinical indicators of ALL patients was compared.All patients with ALL were followed up and the overall survival(OS)and disease-free survival(DFS)were calculated.The COX regression model was used to analyze the related factors affecting the prognosis of adult ALL patients.Results The expression levels of GLUT3 in bone marrow mononuclear cells of patients in ALL group were significantly higher than those in control group(P<0.05).The GLUT3 expression levels in B-ALL group,T-ALL group,Ph-positive group and Ph-negative group of different types of ALL were significantly higher than those in control group(P<0.05),however,which in complete remission group were significantly lower than those in incomplete remission group(P<0.05),but there were no significant differences between B-ALL and T-ALL(P>0.05).There was no significant difference between Ph-positive group and Ph Ph-negative group(P>0.05).The expression levels of GLUT3 were closely related to patient’s age,WBC count,hemoglobin,and extramedullary invasion of ALL patients(P<0.05).COX regression model analysis showed that age,extramedullary invasion of leukemia and high expression of GLUT3 were independent risk factors affecting OS and DFS in ALL patients.Conclusion GLUT3 is highly expressed during the initial diagnosis and recurrence of adult patients with ALL,and its expression levels may be related to the efficacy of ALL treatment and the prognosis of patients.