诱导化疗后造血功能恢复情况和MRD状态对初诊断急性髓系白血病患者的预后影响

目的 探讨诱导化疗后造血功能的恢复情况和MRD状态在对AML预后的影响。方法 回顾性分析2017年1月至2020年12月昆明医科大学第二附属医院血液内科初诊的100例急性髓系白血病患者的临床资料。对比分析了形态学完全缓解时外周血血细胞计数完全恢复组(CR)与未完全恢复组(CRi or CRp)患者临床特征的差异性及2组患者OS和EFS的差异;及其对比分析了诱导治疗后第28天血小板完全恢复组(PLT≥300×10^(9)/L)与未完全恢复组(PLT <300×10^(9)/L)2组患者OS和EFS的差异。采用Cox回归分析影响预后的危险因素。采用独立样本t检验和Pearson卡方检验或Mann-Whitney检验评估各种参数的差异性,Kaplan-Meier法及Cox回归进行生存分析。结果 中位随访时间为1.6(0.9,2.6)a,CR组与CRp or CRi组组间比较显示:2组患者在形态学缓解时MRD状态、预后基因(NPM1、FLT3-ITD、C-KIT、CEBPA)、预后存在统计学差异(P <0.05);形态学缓解时外周血细胞计数恢复不完全的AML患者预示着更差的结局,其中未完全恢复组(CRi or CRp)组与完全恢复组(CR)比较,总体生存时间(OS)明显缩短(3.2 a VS 1.8 a,P=0.016);和无进展生存期(EFS)也明显缩短(未达到VS 1.2 a,P=0.041)。诱导治疗第28天血小板未完全恢复组(PLT <300×10^(9)/L)与血小板计数完全恢复组(PLT≥300×10^(9)/L)相比,总体生存时间(OS)明显缩短(5.2 a VS 2.5 a,P=0.001);EFS也缩短(3.2 a VS 2.7 a,P=0.237)。Cox回归分析显示:第28天血小板恢复情况、形态学缓解时MRD状态是影响AML患者预后的独立危险因素。结论 对于初诊的AML患者,诱导化疗后的造血功能再生,特别是血小板的恢复,是AML患者预后的重要预测因子。尽管造血功能恢复情况与MRD状态是相关的,但2者都是AML患者复发、OS和EFS的独立预后因素。

Identification and expression analysis of chlorogenic acid biosynthesis key gene PpHCT in peach

Shikimic acid/quinic acid hydroxy cinnamyl transferase(HCT)is one of the key enzymes in the phenylpropanoid pathway.However,the role of the HCT gene in chlorogenic acid(CGA)biosynthesis in peach fruit remains unclear.For this,we identified the accumulation pattern of CGA in four peach cultivars,cloned and characterized 11 PpHCT gene members,and further analyzed the expression patterns of these PpHCT genes during fruit development.The contents of CGAs in the four peach cultivars all exhibited a trend of increasing and then decreasing during the fruit growth and development.Moreover,the contents of CGAs in the peel and flesh were tissue-specific.Gene structure analysis indicated that the PpHCT genes were highly conserved,containing two exons and one intron.The protein structure analysis demonstrated that the PpHCT proteins contained two conserved motifs(HXXXD,DFGWG)and a transferase domain(PF02458),which belonged to the BAHD acyltransferase family.The cis-acting element analysis suggested that the promoters of PpHCT genes contained many light-related,hormone-related,stress-related,tissue-specific,and circadian-related elements,and they could participate in a variety of biological processes.Phylogenetic analysis showed that the HCT proteins of peach were closely related to the HCT proteins of plum and had a close evolutionary relationship.The qRT-PCR analysis indicated that the expression levels of PpHCT1 and PpHCT2 showed an opposite trend to the accumulation of CGA,whereas the expression levels of PpHCT4,PpHCT5,PpHCT7,PpHCT8,and PpHCT11 demonstrated the same trend as CGA accumulation.It was worth noting that only PpHCT4 and PpHCT5 were highly expressed in the two high-CGA cultivars but showed low levels of expression in the two low-CGA cultivars.Therefore,it was hypothesized that these two genes might be key genes to the synthesis of CGA in peach fruit.Those findings provide a theoretical basis for further study on the biological functions of the HCT gene and help to reveal the molecular mechanism of CGA.