格列卫对慢性粒细胞白血病病人Ph染色体和bcr／abl融合基因表达影响

目的探讨格列卫治疗Ph染色体阳性慢性粒细胞白血病病人后骨髓Ph染色体及bcr／abl融合基因表达的变化。方法采用R显带和半定量RTPCR分别检测11例慢性粒细胞白血病病人服用格列卫前后骨髓标本中Ph染色体和bcr／abl基因的表达。结果用药后9例慢性期慢性粒细胞白血病病人，7例分别在用药3～24个月后染色体检查为Ph染色体阴性，1例用药1个月后其Ph染色体仍为阳性，后失访；1例用药2个月后Ph染色体阳性率为30％；1例急变期慢性粒细胞白血病病人用药6个月后其Ph染色体阳性率为70％；1例加速期慢性粒细胞白血病病人用药12个月后Ph染色体阳性率为60％。服用格列卫的CML病人Ph染色体转阴后仍能检测到bcr／abl基因的表达，但其表达水平较用药前明显降低，差异有显著性（t=3．77、5．13，P〈0．01），随着用药时间的延长bcr／abl基因表达逐渐降低。结论格列卫能有效治疗Ph染色体阳性的慢性粒细胞白血病病人，并且对其预后具有重要的意义。

THE EFFECT OF GLIVEC ON Ph CHROMOSOME AND bcr/abl mRNA EXPRESSION IN CHRONIC MYELOCYTIC LEUKEMIA

Objective To investigate the changes of Ph chromosome in bone marrow and bcr/abl mRNA levels in patients with chronic myeloid leukemia （CML） after treatment with Glivec. Methods By using R banding technique and semi-quantitative RT-PCR, Ph chromosomes and bcr/ahl mRNA levels in bone marrow samples of 11 CML patients were detected before and after the administration of Glivec. Results Of the nine patients, Ph chromosome was negative in seven after three to 24 months of treatment; one patient still showed positive Ph chromosome after one-month medication and lost follow-up later; one patient showed the positive rate of Ph chromosome of 30%. The positive rate of Ph chromosome in one patient with blast crisis CML after six-month treatment was 70M. One patient with accelerated-phase CML after 12-month treatment showed 70% of positive Ph chromosome. Although bcr/abl mRNA expression could still be detected in patients with CML even after Ph chromosome became negative, the level was significantly lower than that of before treatment （t= 3.77,5.13;P〈0.01）. The level of bcr/abldecreased gradually along with the extcntion of medication. Conclusion Glivec can effectively treat CML patients with positive Ph chromosome, which is of great significance of the prognosis of the disease.