急性髓系白血病患者治疗前后血管内皮生长因子及其受体的变化

Change of vascular endothelial growth factor and its receptors expression in acute myeloid leukemia before and after treatment

目的 探讨急性髓系白血病 (AML)中血管生成的作用。方法 用ELISA法检测AML骨髓单个核细胞培养上清血管内皮生长因子 (VEGF)的表达 ;应用免疫组化技术检测 2 8例初治AML患者治疗前后的骨髓活检标本VEGF及受体Flt 1、KDR和微血管密度 (MVD)的变化。结果 AML患者骨髓细胞VEGF的分泌量 (42 5 .31ng L)大于对照组 (14 0 .12ng L)。初治AML患者骨髓病理组织中VEGF、KDR和Flt 1的表达 (分别为 78.6 %、78.6 %和 7.1% )高于对照组 (分别为 10 .0 %、5 .0 %和 5 .0 % ) (P值均 <0 .0 5 ) ;VEGF与MVD及KDR呈正相关 ;化疗后完全缓解组骨髓组织的VEGF、KDR阳性率及MVD明显下降 (P <0 0 5 ) ,化疗后未完全缓解组的VEGF、KDR阳性率及MVD与治疗前相比无显著性下降(P >0 .0 5 ) ;Kaplan Meier分析显示治疗前VEGF阳性组和MVD高表达组的生存时间分别大于VEGF阴性组和MVD低表达组 (P <0 0 5 ) ,但治疗前KDR表达情况与生存时间无关 (P >0 .0 5 )。结论 AML骨髓组织中存在血管生成 ,VEGF KDR信号传导通路在急性白血病血管新生中起主要作用 ,VEGF的表达与AML的预后有关。

Objective To explore the role of angiogenesis in bone marrow in acute myeloid leukemia(AML). Methods Bone marrow culture supernatant was assayed for vascular endothelial growth factor (VEGF) by ELISA, bone marrow biopsies from 28 newly diagnosed AML patients were assayed for microvessel density (MVD),VEGF and its receptors KDR, Flt-1 by immunohistochemical staining before and after induction chemotherapy. Results Culture supernatant of AML bone marrow mononuclear cells showed higher amount of VEGF(425.31 ng/L) than that of control (140.12 ng/L). The VEGF and KDR expressions and MVD were significantly higher in newly diagnosed AML patients (78.6%, 78.6% and 7.1%, respectively) than that of control group(P<0.05). There was a positive correlation between VEGF, KDR and MVD. The positive rate of VEGF, KDR and MVD reduced to normal after the patients achieved complete remission, while in non-remission patients did not. Kaplan-Meier analysis showed that the survival time was longer in VEGF negative group than in VEGF positive group. The pre-treatment MVD and VEGF had no correlation with survival time. Conclusions There is remarkable angiogenesis in AML and VEGF/KDR signaling pathway takes an important role in the pathological angiogenesis .VEGF could be used as a prognostic factor in AML.