急性髓系白血病患者WT1基因表达水平及其在微小残留病灶监测中的临床意义

Expression level of WT1 gene in patients with acute myeloid leukemia and its clinical significance in monitoring of minimal residual disease

目的:探讨急性髓系白血病(AML)患者WT1基因表达水平及其在微小残留病灶(MRD)监测中的临床意义。方法:采用实时荧光定量聚合酶链反应(RQ-PCR)检测59例AML患者(AML组)WT1基因表达水平并与16例骨髓分类正常患者(对照组)进行比较。比较不同临床特征、核型AML患者WT1基因表达水平。分析AML患者WT1基因与融合基因AML1-ETO、CBFβ-MYH11表达水平的相关性。结果:AML组WT1基因表达水平显著高于对照组(P<0.01)。不同年龄、性别及白细胞计数AML患者WT1基因表达水平比较,差异无统计学意义(均P>0.05)。FAB分型中,M_(3)与M_(4)型患者WT1基因表达水平较高,但两者比较差异无统计学意义(P>0.05);与M_(2)型患者比较,M_(3)型患者WT1基因表达水平较高,M_(5)型患者WT1基因表达水平较低(均P<0.05);M_(5)型患者WT1基因表达水平亦低于M_(4)型患者(P<0.05)。异常核型患者WT1基因表达水平高于正常核型患者(P<0.05)。t(15;17)/PML-RARa和t(16;16)/CBFβ-MYH11患者WT1基因表达水平比较,差异无统计学意义(P>0.05)。复杂核型和t(8;21)/AML1-ETO患者WT1基因表达水平低于t(15;17)/PML-RARa患者(均P<0.05)。除1例AML1-ETO阳性AML患者复发时AML1-ETO升高而WT1基因表达水平未升高,没有同步提示疾病复发外,其他跟踪的AML患者WT1与AML1-ETO、CBFβ-MYH11基因表达水平呈正相关(均P<0.05)。结论:采用RQ-PCR检测WT1基因表达水平,可以监测AML患者MRD,评估疗效与预后,预测疾病复发风险。

Objective:To investigate the expression level of WT1 gene in patients with acute myeloid leukemia(AML)and its clinical significance in the monitoring of minimal residual disease(MRD).Methods:The expression level of WT1 gene in 59 patients with AML(AML group)and 16 patients with normal bone marrow classification(control group)was detected by RQ-PCR and compared.The expression level of WT1 gene in AML patients with different clinical characteristics and karyotypes was compared.The correlation between the expression levels of WT1 gene and fusion gene AML1-ETO,CBFβ-MYH11 in AML patients was analyzed.Results:The expression level of WT1 gene in the AML group was significantly higher than that in the control group(P<0.01).There was no statistically significant difference in the WT1 gene expression level of AML patients with different ages,genders and white blood cell counts(all P>0.05).In FAB classification,the WT1 gene expression level of M_(3) and M_(4) patients was higher,but the difference between the two was not statistically significant(P>0.05);compared with M_(2) patients,the WT1 gene expression level of M_(3) patients was higher,that of M_(5) patients was lower(all P<0.05);the expression level of WT1 gene in M_(5) patients was also lower than that in M_(4) patients(P<0.01).The expression level of WT1 gene in patients with abnormal karyotype was higher than that in patients with normal karyotype(P<0.05).There was no significant difference in the expression level of WT1 gene between t(15;17)/PML-RARa and t(16;16)/CBFβ-MYH11 patients(P>0.05).The WT1 gene expression level of patients with complex karyotype and t(8;21)/AML1-ETO was lower than that of patients with t(15;17)/PML-RARa(both P<0.05).Except for 1 AML1-ETO-positive AML patient with relapse,AML1-ETO increased,but WT1 gene expression level did not increased,and there was no simultaneous indication of disease recurrence,and WT1,AML1-ETO,CBFβ-MYH11 gene expression levels of other follow-up AML patients were positive correlation(all P<0.05).Conclusion:Using RQ-PCR to detect the expression level of WT1 gene can monitor the MRD of AML patients,evaluate the efficacy and prognosis,and predict the risk of disease recurrence.