Snail基因在小儿急性淋巴细胞性白血病中的表达及预后价值

Expression and prognostic role of Snail in pediatric acute lymphoblastic leukemia

目的 观察Snail基因在小儿急性淋巴细胞性白血病(ALL)中的表达水平,探讨其在ALL中的预后价值。方法 应用实时定量荧光定量聚合酶反应(RT-PCR)检测42例小儿ALL患者骨髓中的Snail mRNA表达,并结合初诊时临床特征进行分析。结果 (1)初诊时高白细胞组的Snail mRNA表达显著高于非高白细胞组[(32.38±2.34)vs(25.06±1.94),P<0.001];(2)治疗后达完全缓解/部分缓解组的Snail mRNA表达明显低于未缓解组[(13.89±3.54)vs(25.98±4.21),P<0.001];(3)有中枢神经系统白血病(CNS-L)组的Snail mRNA明显高于无CNS-L组[(26.47±5.59)vs(19.62±3.28),P<0.001];(4)Snail基因表达与危险分层具有明显相关性(P=0.0001),低危组Snail基因表达显著低于中危组(P=0.001)与高危组(P=0.0001),但中危与高危组间比较差异无统计学意义(t=1.37,P=0.18)。结论 Snail基因表达与初诊时白细胞数、危险分层及疗效密切相关,且与小儿ALL的CNS浸润呈正相关,可作为疗效判断与预测继发CNS-L发生的潜在观察指标。

Objective To explore the prognostic role of Snail gene in pediatric acute lymphoblastic leukemia(ALL).Methods The level of Snail mRNA in bone marrow from 42 consecutive pediatric ALL patients were examined by Real-time PCR.The relation of Snail expression with clinical features was analyzed at initial diagnosis.Results(1) The expression of Snail in pediatric ALL subgroup with hyperleukocytosis was higher than that without hyperleukocytosis(32.38 ±2.34 vs.25.06±1.94,P<0.001).(2)Compared to those with complete partial remission,enhanced level of Snail was found in the patients who did not achieve remission(13.89±3.54 vs.25.98±4.21,P<0.001).(3) The subgroup with central nervous system leukemia(CNS-L) possessed higher expression of Snail in comparison with that without CNS-L(26.47±5.59 vs.19.62±3.28,P<0.001).(4) Significant relation was found between Snail expression and risk stratification of pediatric ALL.The low risk subgroup exhibited lower expression of Snail than intermediate and high risk subgroups.However,no marked difference of Snail expression existed between intermediate and high risk subgroups.Conclusion The expression of Snail mRNA was closely related with leukocyte count at initial diagnosis,risk stratification,and efficacy.High Snail level was positively associated with the infiltration of CNS-L.The level of Snail may be considered as a potential prognostic index for efficacy and secondary CNS-L in pediatric ALL.