糖皮质激素受体表达水平与急性淋巴细胞白血病诱导治疗疗效的相关性

目的探讨在儿童急性淋巴细胞性白血病（ALL）患儿中进行胞浆糖皮质激素受体（GR）检测及其与治疗效果的相关性,探讨GR能否作为判断儿童ALL预后的因素。方法利用GR的单克隆抗体,通过流式细胞仪检测48例初治ALL患儿的骨髓液（起病时和疾病获缓解时）和15例随机长期持续缓解（CCR）状态下ALL患儿骨髓液及30例正常儿童外周血液单个核细胞胞浆GR表达水平,分析其与疾病疗效的关系。并对前期实验组进行临床追踪,分析前期实验数据与CCR或复发的关系。结果初发ALL患儿起病时GR与治疗后是否获得缓解（CR）无相关性（P=0.56）;起病时GR表达水平与CR时GR表达水平无统计学差异（P=0.10）;与疾病缓解时的骨髓微小残留病（MRD）指标无相关性（P=0.54）。患儿CR时其GR与正常对照组GR表达水平无统计学差异（P=0.21）。对前期实验组追踪结果显示,起病时GR表达水平与CCR或疾病复发不存在统计学差异（P=0.45）;15例CCR患儿GR表达水平,与正常对照组比较,二者无统计学差异（P=0.28）。结论ALL患儿起病时其基础水平胞浆GR表达与治疗后缓解率、缓解时MRD水平、疾病长期持续缓解或复发无相关性,不能作为独立判断疾病的预后因素。而ALL患儿缓解及长期持续缓解时其胞浆GR与正常儿童GR表达水平无差异,故动态监测胞浆GR表达水平意义不大。

Relationship between Expression Level of Glucocorticoid Receptor and Treatment Outcome in Children with Acute Lymphoblastic Leukemia

Objective To study the relationship between the initial expression level of glucocorticoid receptor (GR) and the treatment outcome in children with acute lymphoblastic leukemia (ALL). And to evaluate if the initial expression level of GR could be the prognostic factor for children with ALL.Methods Anti-GR-antibody was used to measure the GR expression level in the bone marrow samples from 48 newly diagnosed children with ALL with flow cytometry. Also the GR expression levels in the patients at complete remission were mea-sured. Fifteen randonmized samples from ALL patients in continuous complete remission (CCR) were measured in this study. The GR expre-ssion levels of 30 blood samples from children in control group were monitored. Results The initial GR expression level had no association with the results after therapy. The GR expression level in CR and CCR had no statistic difference compared with that in control group.Conclusions It is not clear yet if the initial GR expression level could be the prognostic factor in children with ALL. Monitoring dynamic changes of the GR expression level in children with ALL seems to be of no remarkable significance.