PD-L1的表达与初发急性白血病患者临床特征及预后关系的研究

Relationship of PD-L1 Expression with the Clinical Features and Prognosis of Patients with Primary Acute Leukemia

目的:探讨初发急性白血病(AL)患者的临床特征与PD^-L1表达的关系以及PD^-L1与急性白血病患者预后的关系。方法:选取本院血液科2013年1月至2015年5月收治的60例初发急性白血病患者作为AL组,选取同期就诊40例健康患者作为健康对照组。采用流式细胞术检测这些患者血清中的PD^-L1表达水平,搜集患者的临床资料,并追踪治疗情况,以及初发急性白血病患者组的病死率,比较不同类型初发急性白血病患者在PD^-L1不同表达水平的治疗疗效。结果:初发急性白血病组PD^-L1^+表达率明显高于正常对照组,差异有统计学意义(P<0.05);在初发急性白血病患者组中PD^-L1^+与PD^-L1^-患者的年龄、性别、白细胞数、血小板数、血红蛋白数、骨髓中原始细胞比例均无统计学差异(P>0.05);初发急性白血病PD^-L1^+患者1和2个疗程后的完全缓解率均明显低于PD^-L1^-患者,差异有统计学意义(P<0.05);在初发急性白血病组中,PD^-L1^+患者经各种治疗措施治疗无效的死亡率明显高于PD^-L1^-患者,远期生存率明显低于PD^-L1^-患者,差异均具有统计学意义(P<0.05);ALL患者PD^-L1阳性表达率与AML患者比较无统计学差异(P>0.05)。ALL和AML患者中PD^-L1^+患者近期缓解率及远期生存率均明显低于PDL1^-患者,远期死亡率明显高于PD^-L1^-患者,差异均有统计学意义(均P<0.05)。结论:PD^-L1在初发急性白血病患者中的阳性表达率较高,PD^-L1的监测对患者后期的治疗效果及预后评估具有一定的指导意义。

Objective:To investigate the relationship of PD-Ll expression with the clinical features and prognosis of patients with primary acute leukemia.Methods:Sixty patients with primary acute leukemia(AL) from January 2013 to May 2015 in our hospital were selected as AL group,while 40 healthy persons were selected as control group.The flow cytometry was used to detect the PD-L1 expression in serum,the clinical data were collected and the treatment and lethality in AL patients were traced;the therapeutic efficacy in AL patients with different expression level of PD-Ll was compared.Results:The expression rate of PD-L1^+ in primary AL patients was significantly higher than that in controls(P <0.05).There was no significant difference in age,sex,WBC count,Plt count,Hb level and blast ratio in bone marrow between PD-L1^+ and PD-Ll patients(P >0.05).The complete remission rate in PD-L1^+ patients was all lower than that of the negative patients after 1 and 2 course of treatment,the difference was statistically significant(P <0.05);the death rate of PD-L1^+ patients was higher than that of PD-L1^-patients after treatment,while the survival rate of PD-L1^+ patients was lower than that of PD-L1^-patients,the difference between 2 groups was statistically significant(P <0.05);the expression rate of PD-L1^+ in patients with ALL was not significantly different from that in AML(P >0.05).The short-term remission rate and long-term survival rate of PD-L1^+ patients were significantly lower than those of PD-L1^-patients,while the long-term mortality was statistically significant higher than that of PD-L1^-patients in ALL and AML patients(P <0.05).Conclusion:The positive expression rate of PD-Ll in the patients with acute leukemia is higher,providing an indication for the evaluation of treatment efficacy and prognosis of patients.