WT1基因在急性白血病中的表达及其临床意义

 【摘要】　目的　探讨急性白血病（AL）患者体内WT1基因的表达情况及其临床意义。方法　采用荧光定量聚合酶链反应对急性髓系、淋巴细胞白血病66例患者WT1基因进行检测，并比较髓系各亚型之间的基因表达量差异，观察基因表达水平与病程及预后之间的相关性，同时分析造血干细胞移植患者的病程与WT1基因表达之间的关系。结果　66例患者中，87.5 %（14／16）的急性淋巴细胞白血病及76.0 %（38／50）的急性髓系白血病患者WT1基因表达阳性；髓系各亚型中，M3的表达水平低于其他各亚型（与M1、M2、M4、M5相比，P值分别为0.040、0.007、0.006、0.010）。WT1基因的表达水平与疾病状态密切相关，完全缓解组表达水平明显低于未缓解组（P＝0.018）及复发组（P＝0.003），其滴度的再次升高可提前1.5个月预测复发。WT1基因与造血干细胞移植患者的预后相关，WT1基因转阴的患者较持续表达及一度下降后再次上升的患者预后好。结论　WT1基因在AL患者中的表达可代表微小残留病灶，急性髓系白血病各亚型中M3表达水平相对较低，WT1表达水平与临床病程及预后密切相关。

Expression of WT1 gene in acute leukemia and its clinical significance

【Abstract】　Objective　To investigate the expression level and clinical significance of WT1 gene in acute luekemia (AL) patients. Methods　WT1 gene level was detected by real time quantitative-polymerase chain reaction in acute myelogenous leukemia (AML) and in acute lymphocytic leukemia (ALL) patients. Then the expression levels of WT1 gene in different subtypes of AML were compared, and the correlation between gene expression and disease courses and prognosis were observed. Moreover, the relationship between disease courses and WT1 expression in patiens after receiving haemopoietic stem cell transplantation were analyzed. Results　Among 66 cases, WT1 expression positive rate was 87.5 % (14/16) in AML and 76.0 % (38/50) in ALL. In AML, the expression level in M3 showed the lowest than that in any other subtypes (compared with M1, M2, M4, M5, P value was 0.040, 0.007, 0.006 and 0.01, respectively). The expression level of WT1 was closely correlated with leukemia disease courses. The expression level in complete remission (CR) group showed a significant lower expression level than that in non-remission group (P = 0.018) and relapse group (P = 0.003), and the re-increase of WT1 expression level could predict relapse as early as 1.5 months. Moreover, WT1 expression also showed an close relationship with prognosis of patients receiving haemopoietic stem cell transplantation. Patients whose WT1 was undetectable had a better prognosis than those with persistent expression, and increase again after becoming undetectable. Conclusion　WT1 has a high expression level in AL, which can represent minimal residual disease. The expression level in M3 was lowest than that in different AML subtypes, and its expression level has a close correlation with clinical disease course and prognosis of AL.