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Host markers and correlated mutations in the overlapping genes of influenza viruses: M1, M2;NS1, NS2;and PB1, PB1-F2 被引量:7
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作者 Wei Hu 《Natural Science》 2010年第11期1225-1246,共22页
The influenza A viruses have three gene segments, M, NS, and PB1, which code for more than one protein. The overlapping genes from the same segment entail their interdependence, which could be reflected in the evoluti... The influenza A viruses have three gene segments, M, NS, and PB1, which code for more than one protein. The overlapping genes from the same segment entail their interdependence, which could be reflected in the evolutionary constraints, host distinction, and co-mutations of influenza. Most previous studies of overlapping genes focused on their unique evolutionary constraints, and very little was achieved to assess the potential impact of the overlap on other biological aspects of influenza. In this study, our aim was to explore the mutual dependence in host differentiation and co-mutations in M, NS, and PB1 of avian, human, 2009 H1N1, and swine viruses, with Random Forests, information entropy, and mutual information. The host markers and highly co-mutated individual sites and site pairs (P values < 0.035) in the three gene segments were identified with their relative significance between the overlapping genes calculated. Further, Random Forests predicted that among the three stop codons in the current PB1-F2 gene of 2009 H1N1, the significance of a mutation at these sites for host differentiation was, in order from most to least, that at 12, 58, and 88, i.e., the closer to the start of the gene the more important the mutation was. Finally, our sequence analysis surprisingly revealed that the full-length PB1-F2, if the three stop codons were all mutated, would function more as a swine protein than a human protein, although the PB1 of 2009 H1N1 was derived from human H3N2. 展开更多
关键词 2009 H1N1 Co-mutation Correlation host Marker INFLUENZA INFORMATION Entropy Mutual INFORMATION mutation Overlapping Genes Random FORESTS
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Novel host markers in the 2009 pandemic H1N1 influenza a virus
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作者 Wei Hu 《Journal of Biomedical Science and Engineering》 2010年第6期584-601,共18页
The winter of 2009 witnessed the concurrent spread of 2009 pandemic H1N1 with 2009 seasonal H1N1. It is clinically important to develop knowledge of the key features of these two different viruses that make them uniqu... The winter of 2009 witnessed the concurrent spread of 2009 pandemic H1N1 with 2009 seasonal H1N1. It is clinically important to develop knowledge of the key features of these two different viruses that make them unique. A robust pattern recognition technique, Random Forests, was employed to uncover essential amino acid markers to differentiate the two viruses. Some of these markers were also part of the previously discovered genomic signature that separate avian or swine from human viruses. Much research to date in search of host markers in 2009 pandemic H1N1 has been primarily limited in the context of traditional markers of avian-human or swine-human host shifts. However, many of the molecular markers for adaptation to human hosts or to the emergence of a pandemic virus do not exist in 2009 pandemic H1N1, implying that other previously unrecognized molecular determinants are accountable for its capability to infect humans. The current study aimed to explore novel host markers in the proteins of 2009 pandemic H1N1 that were not present in those classical markers, thus providing fresh and unique insight into the adaptive genetic modifications that could lead to the generation of this new virus. Random Forests were used to find 18 such markers in HA, 15 in NA, 9 in PB2, 11 in PB1, 13 in PA, 10 in NS1, 1 in NS2, 11 in NP, 3 in M1, and 1 in M2. The amino acids at many of these novel sites in 2009 pandemic H1N1 were distinct from those in avian, human, and swine viruses that were identical at these positions, reflecting the uniqueness of these novel sites. 展开更多
关键词 2009 PANDEMIC H1N1 host Switch INFLUENZA mutation Random FORESTS
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Nucleotide host markers in the influenza A viruses
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作者 Wei Hu 《Journal of Biomedical Science and Engineering》 2010年第7期684-699,共16页
In the efforts to understand the molecular characteristics responsible for the ability of influenza viruses to cross species, various amino acid host markers in influenza viruses were uncovered. Our previous study ide... In the efforts to understand the molecular characteristics responsible for the ability of influenza viruses to cross species, various amino acid host markers in influenza viruses were uncovered. Our previous study identified a collection of novel amino acid host markers in ten proteins of 2009 pandemic H1N1. As an extension of our prior work, the objective of the current study was to employ Random Forests, a robust pattern recognition technique, to discover nucleotide host makers in the ten corresponding genes of 2009 pandemic H1N1, along with those in the genes of avian and swine viruses. Although different, there was an association between the amino acid markers in proteins and the nucleotide markers in the related genes due to codon translations. Moreover, nucleotide host markers have the capability to indicate important positions within a codon for host switches as well as the significance of synonymous mutations on host shifts, all of which amino acid markers could not provide. Our findings highlighted that two or even three nucleotide markers could coexist within a single codon, and the different importance values of these markers could further discri- minate the multiple markers within a codon. The nucleotide markers found in this study rendered a comprehensive genomic view of the complex and systemic nature of host adaptation. They verified and enriched the known amino acid markers and offered a larger set of finer host markers for further experimental confirmation. 展开更多
关键词 2009 PANDEMIC H1N1 host Switch Marker INFLUENZA mutation Random FORESTS
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无毒基因在不同寄主梨孢菌中的变异研究 被引量:6
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作者 余欢 姜华 +1 位作者 王艳丽 孙国昌 《浙江农业学报》 CSCD 北大核心 2015年第8期1414-1421,共8页
梨孢菌除侵染水稻外,还可侵染禾本科和莎草科等多种植物,已有研究表明稻区草类寄主的梨孢菌与稻瘟病的发生有关。无毒基因在水稻—稻瘟病菌互作系统中扮演了重要角色,并且无毒基因经常发生变异,可以利用无毒基因变异的特性来研究梨孢菌... 梨孢菌除侵染水稻外,还可侵染禾本科和莎草科等多种植物,已有研究表明稻区草类寄主的梨孢菌与稻瘟病的发生有关。无毒基因在水稻—稻瘟病菌互作系统中扮演了重要角色,并且无毒基因经常发生变异,可以利用无毒基因变异的特性来研究梨孢菌群体的遗传多样性。对35株草类寄主的梨孢菌进行系统进化分析,这些菌株被分为两类,一类是寄主为马唐的菌株,另一类是寄主为牛筋草和狗尾草的菌株。筛选了27对无毒基因引物,对这些草类寄主梨孢菌进行扩增,结果表明无毒基因在这些菌株中的变异类型有完全缺失、插入、不完全缺失、多位点,其中完全缺失为主要的变异类型。进一步对无毒基因的扩出率进行统计,结果表明,供试菌株中没有菌株同时含有所有已克隆的无毒基因,此外,所有供试菌株均没有AVR-Pik/km/kp,PWL3和PWL4基因,以马唐为寄主的菌株中没有ACE1,AVRPiz-t,AVR-Pita1和PWL1;以牛筋草为寄主的菌株中没有AVR-Pia,AVR-Pita1,AVR-Pita2和PWL2;以狗尾草为寄主的菌株中没有AVR-Pii,AVR-Pia,PWL1和PWL2。 展开更多
关键词 梨孢菌 草类寄主 无毒基因 变异
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小西葫芦黄化花叶病毒分离物的3′末端序列多态性研究 被引量:4
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作者 陈洁云 陈集双 洪健 《微生物学报》 CAS CSCD 北大核心 2003年第3期388-394,共7页
研究了来自中国大陆 9个小西葫芦黄化花叶病毒 (ZYMV)分离物的基因组 3′末端核苷酸序列及所推导的外壳蛋白 (CP)氨基酸序列以及 3′末端非编码区 (UTR)序列 ,并与其它地区所报道的 1 6个ZMYV分离物进行了同源性比较。ZYMVCP基因核苷酸... 研究了来自中国大陆 9个小西葫芦黄化花叶病毒 (ZYMV)分离物的基因组 3′末端核苷酸序列及所推导的外壳蛋白 (CP)氨基酸序列以及 3′末端非编码区 (UTR)序列 ,并与其它地区所报道的 1 6个ZMYV分离物进行了同源性比较。ZYMVCP基因核苷酸序列具有一定的寄主相关性和地域相关性 ,但总体上其关联程度不明显 ;同时 ,CP氨基酸序列的寄主适应性程度明显高于地域相关性。 2 5个ZYMV分离物的CP氨基酸序列根据其变异程度分为 2个区 :N端约 41个氨基酸为高度变异区 ,CP核心区和C端氨基酸序列为保守区。研究结果初步揭示了ZYMV作为单链RNA病毒通过与寄主相互作用而表现寄主适应性变异的趋势。 展开更多
关键词 小西葫芦黄化花叶病毒 3′末端序列 多态性 同源性分组 CP保守区 寄主适应性 马铃薯Y病毒属
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异基因造血干细胞移植治疗伴TP53基因突变的髓系肿瘤31例临床分析 被引量:4
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作者 张莹 王安迪 +9 位作者 张春玲 万理萍 杨隽 蔡宇 许晓倩 黄崇媚 邱慧颖 童茵 魏道林 宋献民 《内科理论与实践》 2020年第5期314-320,共7页
目的:研究异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗伴TP53基因突变髓系肿瘤患者的疗效和预后相关因素。方法:纳入2016年1月至2019年12月我院allo-HSCT治疗的患者267例,回顾分析31例伴T... 目的:研究异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗伴TP53基因突变髓系肿瘤患者的疗效和预后相关因素。方法:纳入2016年1月至2019年12月我院allo-HSCT治疗的患者267例,回顾分析31例伴TP53突变髓系肿瘤患者的临床特征和治疗结果,并与236例无TP53突变患者比较分析。结果:伴和不伴有TP53突变患者中位年龄分别为55(2665)岁和41(767)岁(P=0.001);移植时突变组缓解期患者比例(45.2%)显著低于无突变组(64.8%)(P=0.004)。供受者ABO血型相合比例显著低于无突变组(35.5%比53.0%,P=0.013)。所有移植时未缓解(no remission,NR)患者移植后均获得完全缓解(complete remission,CR);植入率、粒系和巨核系植入时间2组无差别。伴TP53突变患者ⅡⅣ度急性移植物抗宿主病(acute graft versus host disease,aGVHD)发生率(33.3%)与无突变组相当(30.0%)(P=0.648);移植后1年中重度慢性GVHD (chronic GVHD,cGVHD)发生率2组相当(18.5%比20.3%,P=0.831)。TP53突变患者与无突变组患者2年累积复发率(cumulative incidences of relapse,CIR)分别为65.6%±1.4%比15.1%±0.1%(P=0.035),2年无复发生存(relapse free survival,RFS)率(10.1%±8.6%比72.2%±3.7%,P<0.001)及总生存(overall survival,OS)率(19.4%±10.7%比74.0%±3.4%,P<0.001)显著降低。多因素分析显示,年龄(≥55岁)、移植时NR同时是伴TP53突变的急性髓系白血病(acute myeloid leukemia,AML)和骨髓增生异常综合征(myelodysplastic syndromes,MDS)患者OS和RFS的预后不良因素,移植前NR患者复发风险是CR患者的3.591倍[风险比(hazard ratio, HR)=3.591, 95%置信区间(confidence interval,CI):1.13611.355, P=0.029]。减低强度预处理(reduced intensity conditioning,RIC)预处理方案、高危核型和未发生cGVHD分别是OS和RFS的预后不良因素。发生cGVHD患者的CIR率显著下降(HR=0.558, 95%CI:0.0825.493, P=0.034)。结论:早期获得缓解并行allo-HSCT是治疗伴TP53突变的AML和MDS的首选方法,高龄、高危核型、移植时NR及RIC预处理方案及未发生cGVHD是影响TP53突变患者移植后生存时间的危险因素。 展开更多
关键词 TP53突变 异基因造血干细胞移植 移植物抗宿主病
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移动目标防御(MTD)关键技术研究 被引量:3
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作者 唐秀存 许强 +1 位作者 史大伟 徐良华 《微型机与应用》 2016年第7期1-5,15,共6页
移动目标防御(Moving Target Defense,MTD)技术是近年来网络空间中"改变游戏规则"的革命性技术之一。它与以往的网络安全技术完全不同,变被动防御为主动防御,其系统和网络状态随着时间、空间以及物理环境等多个维度的变化而... 移动目标防御(Moving Target Defense,MTD)技术是近年来网络空间中"改变游戏规则"的革命性技术之一。它与以往的网络安全技术完全不同,变被动防御为主动防御,其系统和网络状态随着时间、空间以及物理环境等多个维度的变化而不断改变,从而增加入侵者的入侵难度,有效限制己方漏洞暴露的概率。因此,移动目标防御将成为未来网络安全防护技术的重点发展方向。综合研究了MTD主要关键技术及其发展脉络,通过比较分析,提出了目前关键技术的优缺点,并结合网络技术的演化展望了MTD技术的发展前景。 展开更多
关键词 移动目标防御 指令集随机 开放流随机主机突变 突变网络 软件多态
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转座因子和宿主基因组的进化 被引量:1
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作者 金振华 《生命科学》 CSCD 2002年第4期220-222,共3页
转座因子主要是一些“自在”或“无功能”的DNA,其对宿主进化无关紧要的观点受到了质疑。新近的报道指出,它们有增强宿主基因组自身进化,对环境变化作出反应的潜在能力,很可能是遗传多样性的主要源泉。
关键词 转基因子 宿主基因组 突变 进化
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取食不同寄主植物的二个甜菜夜蛾品系对药剂的敏感性 被引量:4
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作者 乐伟 马伟华 王沫 《昆虫知识》 CSCD 北大核心 2009年第3期428-431,共4页
探讨取食不同寄主植物的2种甜菜夜蛾Spodoptera exigua(Hübner)品系对几种常用药剂的敏感性变化情况。试验结果表明,寄主植物对甜菜夜蛾的生长发育和杀虫剂的敏感性有显著影响,取食不同寄主植物以后,甜菜夜蛾2个品系对溴氰菊酯、... 探讨取食不同寄主植物的2种甜菜夜蛾Spodoptera exigua(Hübner)品系对几种常用药剂的敏感性变化情况。试验结果表明,寄主植物对甜菜夜蛾的生长发育和杀虫剂的敏感性有显著影响,取食不同寄主植物以后,甜菜夜蛾2个品系对溴氰菊酯、毒死蜱、溴虫腈、虫酰肼的敏感性均有不同程度的变化,取食不同寄主植物的甜菜夜蛾蛹黑突变品系较甜菜夜蛾正常品系的抗性均要高,2个品系对溴氰菊酯的敏感性变化均较大,最大LD50之比分别达到13.36、12.30倍,2个品系都对虫酰肼的敏感性变化不明显,最大LD50之比分别达到2.54、2.23倍。 展开更多
关键词 甜菜夜蛾 黑色突变型 寄主植物 药剂敏感性
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异基因造血干细胞移植治疗急性淋巴细胞白血病25例的临床分析 被引量:4
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作者 苗巧 汪晶 +3 位作者 蒋曲 邓雪梅 刘香君 张红宾 《检验医学与临床》 CAS 2017年第9期1262-1265,共4页
目的回顾性分析异基因造血干细胞移植(allo-HSCT)治疗急性淋巴细胞白血病(ALL)的疗效。方法收集2009年3月至2015年8月该院行allo-HSCT的25例ALL患者,其中费城染色体阳性(Ph^+)ALL 7例,Ph^-ALL 18例;移植前处于第一次完全缓解(CR1)21例,... 目的回顾性分析异基因造血干细胞移植(allo-HSCT)治疗急性淋巴细胞白血病(ALL)的疗效。方法收集2009年3月至2015年8月该院行allo-HSCT的25例ALL患者,其中费城染色体阳性(Ph^+)ALL 7例,Ph^-ALL 18例;移植前处于第一次完全缓解(CR1)21例,第二次完全缓解(CR2)2例,第二次复发部分缓解(PR)1例,未缓解(UR)1例。其中同胞全相合7例,无关供者全相合3例,亲缘单倍体15例;2例骨髓移植(BMT)+外周血干细胞移植(PBSCT),23例PBSCT。预处理方案:以白消安/环磷酰胺(Bu/Cy)为主16例,全身照射(TBI)/Cy者8例,氟达拉滨(Flu)/Bu者1例。常规采用环孢菌素A(CsA)、吗替麦考酚酯(MMF)、短程甲氨蝶呤(MTX)+抗胸腺细胞球蛋白(ATG)预防急性移植物抗宿主病(aGVHD)。结果移植后25例患者均获得造血重建,中位随访时间为12月。随访结束有14例无病生存8.5~45.0月,1例移植后复发2次,目前仍在继续随访中;总生存率为60%;有10例(40%)死于aGVHD、感染、移植相关的血栓性微血管病等相关并发症及疾病复发;非复发病死率为24%。结论 allo-HSCT是治疗急性淋巴细胞白血病患者的有效方法,但需进一步探索避免移植后复发及严重并发症的方案。 展开更多
关键词 异基因造血干细胞移植 急性淋巴细胞白血病 复发 移植物抗宿主病 突变
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SARS-CoV-2溯源新进展 被引量:2
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作者 何文巧 陈清 《南方医科大学学报》 CAS CSCD 北大核心 2020年第12期1838-1842,F0003,共6页
从2019年12月~2020年11月19日,COVID-19大流行已导致全球55928327例确诊病例,造成1344003人死亡。但是,我们对这次疫情的病原体-新型冠状病毒(SARS-CoV-2)的来源仍然未了解清楚。本综述总结和分析SARS-CoV-2溯源研究进展,为进一步的研... 从2019年12月~2020年11月19日,COVID-19大流行已导致全球55928327例确诊病例,造成1344003人死亡。但是,我们对这次疫情的病原体-新型冠状病毒(SARS-CoV-2)的来源仍然未了解清楚。本综述总结和分析SARS-CoV-2溯源研究进展,为进一步的研究提供启示。现有证据表明SARS-CoV-2有可能是在40~70年前由蝙蝠冠状病毒分化而来;该病毒在进化过程中同时存在多种变异及自然选择现象,病毒基因不同区域可能发生不同变异并受到不同的选择压力,这些都增加了病毒溯源的困难性;有多种动物被认为可能是SARS-CoV-2的宿主,包括猫、狮子、老虎、狗、水貂等;SARS-CoV-2可能可由人类传播给动物,且该病毒也可以在动物间互相传播;现有证据不支持该病毒的源头是中国。我们仍未清楚该病毒如何传播到人类,仍然需要更多的研究去探索SARS-CoV-2的来源、宿主、中间宿主及其跨物种传播的机制。 展开更多
关键词 SARS-CoV-2 宿主 溯源 进化 变异
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Characteristic sites in the internal proteins of avian and human influenza viruses
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作者 David King Zachary Miller +1 位作者 Wesley Jones Wei Hu 《Journal of Biomedical Science and Engineering》 2010年第10期943-955,共13页
The capacity of zoonotic influenza to cross species boundaries to infect humans poses a global health threat. A previous study identified sites in 10 influenza proteins that characterize the host shifts from avian to ... The capacity of zoonotic influenza to cross species boundaries to infect humans poses a global health threat. A previous study identified sites in 10 influenza proteins that characterize the host shifts from avian to human influenza. Here, we used seven feature selection algorithms based on machine learning techniques to generate a novel and extensive selection of diverse sites from the nine internal proteins of influenza based on statistically importance to differentiating avian from human viruses. A set of 131 sites was generated by processing each protein independently, and a selection of 113 sites was found by analyzing a concatenation of sequences from all nine proteins. These new sites were analyzed according to their annual mutational trends. The correlation of each site with all other sites (one-to-many) and the connectivity within groups of specific sites (one-to-one) were identified. We compared the performance of these new sites evaluated by four classifiers against those recorded in previous research, and found our sites to be better suited to host distinction in all but one protein, validating the significance of our site selection. Our findings indicated that, in our selection of sites, human influenza tended to mutate more than avian influenza. Despite this, the correlation and connectivity between the avian sites was stronger than that of the human sites, and the percentage of sites with high connectivity was also greater in avian influenza. 展开更多
关键词 CONNECTIVITY Correlation Feature Selection host SPECIFICITY INFLUENZA Machine Learning mutation
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Molecular Features of Highly Pathogenic Avian and Human H5N1 Influenza A Viruses in Asia
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作者 Wei Hu 《Computational Molecular Bioscience》 2012年第2期45-59,共15页
The highly pathogenic avian H5N1 influenza virus could infect humans with high mortality rate, even though it has not yet become efficiently transmissible among humans. This proteomic study investigated the molecular ... The highly pathogenic avian H5N1 influenza virus could infect humans with high mortality rate, even though it has not yet become efficiently transmissible among humans. This proteomic study investigated the molecular basis of interspecies transmission and host range of this lethal virus in Asia, due to its potential pandemic threat. Although there are host markers located in previous research between general avian and human influenza viruses, the novelty of our work was to uncover host markers between highly pathogenic avian and human H5N1 viruses in Asia. Many host markers we found were not present in the previous general markers, thus expanding the current repertoire of host markers with these strain-specific host markers. Ranked by their order of importance, the top 10 host markers discovered in this report were PB2_627, HA_325, NS1_205, PB2_524, HA_86, NA_201, NP_373, NS1_7, HA_156, NA_74, confirming our current knowledge that PB2_627 is the most critical site for distinguishing avian and human H5N1. We also identified several naturally-occurred mutations in the HA protein that might shift the receptor binding preference of Asian avian H5N1, since early detection of mutations that might lead to emergence of a new pandemic virus is of prime importance. Finally, we analyzed the distinctive interaction patterns within and between proteins of avian and human H5N1 in Asia at protein level and individual residue level. From multiple viewpoints, our findings reinforced the experimental observation that multiple genes of Asian avian H5N1 are involved in its gradual adaptation to human hosts. 展开更多
关键词 Entropy H5N1 HEMAGGLUTININ host Marker INFLUENZA Informational Spectrum Method mutation Mutual Information Random Forest Receptor Binding SPECIFICITY
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异基因造血干细胞移植治疗1例伴BCOR、IDH1、NRAS及WT1突变急性髓细胞白血病患者并文献复习
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作者 刘妍 吴涛 +2 位作者 毛东锋 鱼玲玲 白海 《国际输血及血液学杂志》 CAS 2022年第6期523-530,共8页
目的探讨伴多基因突变急性髓细胞白血病(AML)患者的临床特征、诊断及异基因造血干细胞移植(allo-HSCT)过程,并进行相关文献复习。方法选择2020年2月25日,解放军联勤保障部队第九四〇医院收治的1例20岁男性伴B细胞淋巴瘤/白血病6共抑制因... 目的探讨伴多基因突变急性髓细胞白血病(AML)患者的临床特征、诊断及异基因造血干细胞移植(allo-HSCT)过程,并进行相关文献复习。方法选择2020年2月25日,解放军联勤保障部队第九四〇医院收治的1例20岁男性伴B细胞淋巴瘤/白血病6共抑制因子(BCOR)、异柠檬酸脱氢酶(IDH)1、NRAS、Wilms肿瘤基因(WT)1突变AML患者为研究对象。根据患者骨髓细胞形态学、免疫分型、髓系肿瘤二代测序(NGS)等检查结果,对患者进行诊断及治疗。本研究对本例患者的随访截至2020年11月11日。采用回顾性分析方法,对患者的临床特征与诊疗过程进行分析。以"急性髓细胞白血病""BCOR""IDH1""NRAS""WT1""异基因造血干细胞移植""移植物抗宿主病""acute myeloid leukemia""allogeneic hematopoietic stem cell transplantation""graft versus host disease""AML""HSCT""GVHD"为中、英文关键词,在中国知网数据库、万方数据知识服务平台、PubMed数据库中进行相关文献检索,通过阅读筛选与本研究相关文献。检索时间设定为建库至2020年11月30日。本研究遵循的程序符合2013年修订的《世界医学会赫尔辛基宣言》的要求,并且取得患者及其家属知情同意。结果①本例患者因"头晕、乏力半个月"于2020年2月25日在本院血液科就诊。②入院后,本例患者骨髓细胞形态学检查结果示,AML-M5。骨髓细胞免疫分型结果示,恶性原始幼稚髓系细胞比例为10.8%,表达CD34、人类白细胞抗原(HLA)-DR、CD117、CD33、CD64、CD13、CD38、CD123;粒细胞发育明显异常。髓系肿瘤NGS结果示,BCOR、IDH1、NRAS及WT1突变呈阳性。③结合本例患者病史及相关实验室检查结果,患者被诊断为AML-M5,WT1、BCOR、NRAS、IDH1突变呈阳性。本例患者分别于2020年2月29日、4月6日、5月9日接受地西他滨(10 mg/d,d1~5)+TA[吡柔比星(30 mg/d,d6~8)+阿糖胞苷(200 mg/d,d1~7)]方案联合化疗;6月9日复查骨髓细胞形态学检查结果示完全缓解(CR)。随后行HLA单倍体相合异基因造血干细胞移植(allo-HSCT),预处理方案为CBA(克拉曲滨7.5 mg/d×5 d+白消安160 mg/d×4 d+阿糖胞苷3000 mg/d×5 d)方案。患者输注外周血单个核细胞(PBMC)、CD34^(+)细胞数量分别为7.8×10^(8)/kg、1.6×10^(6)/kg。联合环孢素、吗替麦考酚酯及甲氨蝶呤预防移植物抗宿主病(GVHD)。患者移植物植入良好,移植后20 d粒细胞植入,23 d血小板植入;28 d复查骨髓细胞形态学检查结果示CR,微小残留病(MRD)呈阴性,WT1突变定量检查结果为0,供受者嵌合体检查结果为完全嵌合。患者移植1个月后发生皮肤、肠道急性GVHD(aGVHD),予甲泼尼龙联合环孢素、吗替麦考酚酯及对症治疗后好转,其间复查骨髓细胞形态学检查结果示CR。截至随访结束患者仍在持续巩固治疗中。④按照本研究设定的文献检索策略,共筛选出3篇中文文献,报道3例伴本例患者相关基因突变AML患者。其中,1例伴IDH1、NRAS及其他相关基因(NPM1、DNMT3A、TET2、ASXL1、TP53)突变的47岁女性AML患者,经allo-HSCT治疗后达CR;1例伴WT1突变的9岁男性AML患儿,经2次allo-HSCT治疗后均复发,随后予细胞免疫治疗,达CR;1例伴BCOR及其他相关基因(RUNX1、TET2、U2AF1)突变的AML患者,经allo-HSCT治疗,达CR。结论allo-HSCT对于伴多基因突变AML患者疗效尚可,应特别关注患者移植后GVHD的预防,提高患者预后及生存质量。 展开更多
关键词 造血干细胞移植 白血病 髓样 急性 突变 移植物抗宿主病 预后 异基因造血干细胞移植
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