急性白血病多药耐药相关基因表达与临床关系的研究

THE CLINICAL STUDY OF THE EXPRESSION OF MUL TIDRUG RESISTANCE ASSOCIATED GENES IN ACUTE IEUKEMIA

目的 :分析和评估急性白血病 bcl- 2、bax、p170及 CD34 等耐药相关指标表达的临床价值。方法 :p170、CD34 检测采用活细胞间接免疫荧光法 ,bcl- 2、bax检测采用链亲和素—胶体金原位杂交法 (ISH- SAG)。结果 :急性白血病复发难治组的 bcl- 2、bcl- 2 / bax的阳性表达率 (76 .9% ,88.5 % )均显著高于缓解组 (4 4 .1%、2 0 .6 % )及初治组 (4 2 .0 %、5 9.0 % ) (P<0 .0 5 ) ,而 bax的阳性表达率在缓解组 (70 .6 % )显著高于复发难治组 (34.6 % ) (P<0 .0 5 ) ,CD34 的阳性表达在复发难治组 (2 3.1% )显著高于缓解组 (2 .9% ) (P<0 .0 5 ) ,而 p170的表达率在两组之间无显著性差异 (P>0 .0 5 )。疗效分析发现 bcl- 2、bcl- 2 / bax的表达与临床缓解密切相关 ,其阴性组的完全缓解率 (CR)显著高于阳性组 (P<0 .0 5 )。而 p170、CD34 及 bax三个指标均显示与 CR无关 (P>0 .0 5 )。线性相关分析发现 bcl- 2和 bax之间显著相关 (r=0 .33,P<0 .0 1) ,而 p170、CD34 与二者均无相关性。 bcl- 2及 bcl- 2 / bax的敏感性(76 .90 %、88.5 0 % )高于 p170、CD34 及 bax(4 6 .2 %、2 3.1%、34.6 % ) ,这些指标联合检测的敏感性为 92 .3%。结论 :bcl- 2及 bcl- 2 / bax的高表达预示着急性白血病预后不良 。

Objective:To investigate the clinical predictive value of the expression of p1 70、 CD3 4、bcl-2、bax in acute leukemia(AL ) .Methods:69patients with AL were detected for the expres- sion of bcl-2、bax by hybridization with streptavedin-gold(ISH-SAG) and for the expression of p1 70、 CD3 4by monoclonal antibodies and indirect immunofluorescence assay by fluoromicroscope.Results: The positive rate ofbcl-2、bcl-2 / bax was statistically higher in relapsed or refractory group (76.9% , 88.5% ) than that in complete remission(CR) group(44 .1 % ,2 0 .6% ) and initial diagnosed group (42 .0 % ,59.4% ) .the positive rate of bax significantly higher in CR group than that in relapsed or refractory group,the positive rate of CD3 4was significantly higher in relapsed or refractory group than thatin CR group(P<0 .0 5) ,but there was no difference of the positive rate of p1 70 between the two groups(P>0 .0 5) .The expression of bcl-2 and bcl-2 / bax was found to be related with the clinical CR,the CR rate of negative group was significantly higher than that in positive group(P<0 .0 5) ,but p1 70、CD3 4or bax wasn' t associated with CR(P>0 .0 5) .bcl-2 and bax were significantly associated with each other(P<0 .0 5) ,but p1 70、CD3 4weren' t associated with bcl-2 and bax.the sensitivity of bcl-2 and bcl-2 / bax was76.9% ,88.5% ,which was higher than that of p1 70 .CD3 4and bax(46.2 % , 2 3 .1 % ,3 4 .6% ) ,the sensitivity of the combined detection of the four markers was92 .3 % .Conclu- sion:The high expression of bcl-2、bcl-2 / bax could result in poor prognosis of AL,which could be a sensitive marker in presicting the treatment effect and prognosis of AL,and their combined detection was very useful to the clinical analysis of drug resistence.