母亲叶酸代谢相关基因多态性与唐氏综合征发生的关系

目的研究叶酸代谢相关基因多态性在浙南地区汉族妇女中的分布,探讨其与唐氏综合征(Down’s Syn-drome,DS)发生的关系。方法对84例已生育DS患儿的母亲(观察组)和120例生育过正常儿童的母亲(对照组)采用PCR扩增及DNA测序法检测亚甲基四氢叶酸还原酶(MTHFR)基因C677T、A1298C位点;甲硫氨酸合成酶(MTR)基因A2756G位点单核苷酸多态性。结果 MTHFR 677 T基因及CT、TT基因型、MTHFR 1298 C基因及AC、CC基因型、MTR 2756 G基因及AG基因型频率观察组与对照组比较均无统计学意义(P>0.05)。三个位点基因型频率联合分析两组也不存在统计学意义(OR=0.692,P>0.05)。结论浙南地区汉族妇女MTHFR C677T、FTHFR A1298C、MTR A2756G基因型不是DS发生的风险因素;三个基因型的联合频率也未见增加DS发生的风险。     

南方汉族KIR-HLA系统分子遗传多态性与急性白血病的相关性

目的:探讨中国南方汉族人群KIR-HLA系统分子遗传多态性与急性淋巴细胞白血病(acute lymphoblastic leukemia, ALL)、急性髓系白血病(acute myelocytic leukemia, AML)的相关性。方法:对323份成年ALL、350份成年AML患者以及745份随机健康对照的样本,...     

孕期妇女MTHFR、MTRR基因多态性与同型半胱氨酸水平的关系

目的分析甘肃省孕期妇女N5,10-亚甲基四氢叶酸还原酶(N5,10-methylenetetrahydrofolate reductase,MTHFR)C677T、A1298C及甲硫氨酸合成酶还原酶(5-methyltetrahydrofolate-homocysteine methyltransferasereductase,MTRR)A66G位点基因多态性的分布特点,并研究其多态性与血浆同型半胱氨酸(Homocysteine,Hcy)浓度的相关性,为孕期妇女补服叶酸提供理论依据。方法以2016年在甘肃省妇幼保健院做孕期检查的522例孕妇为研究对象,检测MTHFR基因C677T、A1298C和MTRR基因A66G位点的基因型,并测定血浆Hcy浓度,应用t检验与Spearman秩检验比较不同基因型间Hcy浓度的差异。结果 MTHFR基因C677T位点CC型、CT型与TT型分别占26.83%、45.12%、28.05%,A1298C位点AA型、AC型、CC型分别占68.29%、26.83%、4.88%。MTRR基因A66G位点AA型、AG型与GG型分别占53.66%、39.02%、7.32%。MTHFR基因C677T位点等位基因C占49.39%,等位基因T占50.61%,A1298C位点等位基因A占81.71%,C占18.29%。MTRR基因A66G位点等位基因A占73.17%,等位基因G占26.83%。MTHFR基因C677T位点CC型、CT型与TT型Hcy含量分布经两两t检验,P0.05,说明各基因型间Hcy分布差异均有统计学意义。MTHFR基因A1298C位点AA型、AC型、CC型,MTRR基因A66G位点AA型、AG型与GG型Hcy含量分布经两两t检验,P0.05,说明各基因型间Hcy分布差异无统计学意义。MTHFR基因C677T、A1298C和MTRR基因A66G位点多态性各风险组经两两t检验,与未发现风险组比较,低度风险组、中度风险组、高度风险组P均小于0.05,差异具有统计学意义;与低度风险组比较,中度风险组、高度风险组P均大于0.05,差异没有统计学意义;与中度风险组比较,高度风险组P小于0.05,差异有统计学意义。根据Spearman秩相关检验,P0.05,Hcy含量与风险等级具有显著相关性。结论 MTHFR基因C677T、A1298C和MTRR基因A66G位点存在基因多态性,MTHFR基因C677T、A1298C和MTRR基因A66G位点基因多态性与血浆Hcy具有显著相关性,随着基因型风险等级的增加,血浆Hcy浓度增高。     

重型抑郁症患者亚甲基四氢叶酸还原酶基因多态性检测

目的 探讨北方汉族人群5,10-亚甲基四氢叶酸还原酶基因多态性与重型抑郁症的关系。方法 采用病例-对照研究。聚合酶链反应-限制性片段长度多态性技术检测MTHFR C677T及 A1298C基因多态性。结果 （1）对照组677TT基因型频率及T等位基因频率分别为为13.16％和39.80%;1298CC基因型和C等位基因频率分别为1.32%和12.83％;（2）抑郁症组MTHFR 677TT基因型频率（35.53％）明显高于正常对照组（13.16％）（P＜0.001）,677 T等位基因频率（57.24%）明显高于对照组（39.80%）（P＜0.001）。（3）Ligistic回归分析, C677T基因型与疾病的发生有关（P<0.001）。结论MTHFR C677T基因变异与本组重症抑郁症发病有关,是其发病的危险因素;MTHFR A1298C基因变异与本组重症抑郁症发病无关联。     

贵州三个民族亚甲基四氢叶酸还原酶基因的遗传多态性

目的研究贵州汉族、布依族、苗族亚甲基四氢叶酸还原酶(methylenetetrahydrofolate reductase，MTHFR)基因多态性，为贵州少数民族基因多态性数据库的建立提供相关数据。方法应用聚合酶链反应及限制性片段长度多态性检测贵州荔波汉族、布依族、雷山苗族MTHFR基因两个单核苷酸(677及1298位)多态位点的基因频率及基因型频率。结果汉族、布依族、苗族MTHFR677位T等位基因的分布频率分别是22．8％，16．1％，10．6％，MTHFR1298位C等位基因的分布频率分别是28．9％，39．1％，48．7％，677CT／1298AC双杂合子的分布频率分别是16．66％，22．7％，11．1％。在苗族还发现1例677TT／1298CC双纯合子。结论．MTHFR C677T和A1298C多态性存在群体差异；贵州雷山苗族、荔波布依族．MTHFR 1298位有较高的C等位基因频率，贵州雷山苗族MTHFR 1298位C等位基因频率是目前文献报道最高的民族。     

新余市汉族女性MTHFR与MTRR基因多态性分布研究

目的针对新余市汉族女性开展分子流行病学调查,研究叶酸代谢关键酶甲硫氨酸合成酶还原酶(MTRR)和5,10-亚甲基四氢叶酸还原酶(MTHFR)的基因多态性分布。方法以孕期保健的521名汉族健康女性为研究对象,采集口腔黏膜上皮脱落细胞,提取基因组DNA,使用荧光定量PCR方法检测MTHFR C677T、A1298C和MTRR A66G基因多态性,进行统计分析。结果 (1)入组对象的基因多态性分布符合遗传平衡。(2)汉族女性MTHFR 677CC、CT、TT的基因型频率分别为38.6%、47.6%、13.8%,C、T等位基因频率分别为62.4%、37.6%;MTHFR 1298AA、AC、CC的基因型频率分别为65.1%、31.9%、3.07%,A、C等位基因频率分别为81.0%、19.0%;MTRR 66AA、AG、GG的基因型频率分别为60.3%、35.1%、4.61%,A、G等位基因频率分别为77.8%、22.2%。(3)汉族女性MTHFR C677T和A1298C两位点连锁有7种组合,频率最高的是CT/AA(30.5%),没有TT/AC和TT/CC组合。两位点间存在完全连锁不平衡(D'=1.0,r~2=0.124)。结论获取新余市汉族女性MTHFR和MTRR基因多态性的群体遗传学特征,其中关键基因位点MTHFR C677T的高风险TT基因型比例为13.8%,低于已报道的山东淄博、河南新乡、辽宁沈阳等地,高于广东佛山市,说明叶酸利用能力中等,对于高风险人群还需加强孕期管理,同时本研究也为当地人群进行个体化增补叶酸提供理论依据。     

ALOX5基因启动子SP-1结合位点多态性与急性髓系白血病易感性的关系

目的探讨花生四烯5-脂氧合酶基因(arachidonate 5-lipoxygenase gene, ALOX5)基因启动子SP-1结合位点的多态性与成人急性髓系白血病(acute myeloid leukemia, AML)的相关性。方法采用聚合酶链反应-单链构象多态性(PCR-SSCP)分析236例成人AML(实验组)和179例健康体检者(对照组)中ALOX5基因启动子SP-1结合位点的多态性,经PCR产物直接测序法进行验证,利用DNAStar软件对测序结果进行分析。结果检测到ALOX5基因启动子SP-1结合位点有6种基因型,包括4/4、4/5、4/6、5/5、5/6和6/6。在实验组和对照组中,基因型4/4的分布频率为20.30%和10.10%(OR=1.976,95%CI:1.050～3.719,χ~2=4.539,P0.05);基因型4/6的分布频率为10.60%和26.80%(OR=0.386,95%CI:0.215～0.692,χ~2=10.513,P0.05);等位基因6的分布频率为26.90%和30.20%(OR=0.736,95%CI:0.528～1.025,χ~2=3.291,P0.05);SP-1位点的其余基因型、等位基因在实验组和对照组中分布频率差异无统计学意义(P0.05),其可能不是成人AML发病风险的预警指标。结论 ALOX5基因启动子区SP-1结合位点的基因型4/6,等位基因6可能与AML发病风险降低有关,而携带基因型4/4人群可能易患AML。     

MTHFR基因(C677T和A1298C)多态性对初产妇合并子痫前期的影响

目的探讨亚甲基四氢叶酸还原酶(Methylenetetrahydrofolate reductase,MTHFR)基因C677T和A1298C单核苷酸多态性与初产妇合并子痫前期的关系。方法我们收集了150例妊娠合并子痫前期的妇女和150例无疾病的正常妊娠妇女,使用PCR-RFLP法检测MTHFR基因C677T和A1298C多态性。其次,比较患病组A1298C多态性位点呈CC突变基因型的妊娠妇女与对照组A1298C多态性位点呈AA正常基因型的妊娠妇女血浆同型半胱氨酸(Homocysteine,HCy)的水平。结果研究发现只有A1298C的突变基因型CC与子痫前期高风险有关,且基因型频率显著高于对照组(P0.001)。与颈围32cm的子痫前期妊娠妇女相比,颈围≥32cm的所有子痫前期妊娠妇女MTHFR基因A1298C位点均呈现突变基因型CC(P0.001)。患病组A1298C多态性位点呈CC突变基因型的妊娠妇女较对照组A1298C多态性位点呈AA正常基因型的妊娠妇女血浆HCy的水平高(9.21±3.15 vs 7.25±1.77 mmo L/L,P0.05)。结论 MTHFR基因A1298C位点的突变基因型CC是妊娠妇女子痫前期发病的高风险因子。CC突变基因型与颈围的增加和血浆中HCy水平的升高存在密切联系。     

血浆Hcy水平及MTHFR和MTRR基因多态性与复发性流产的相关性研究

目的探讨血清同型半胱氨酸(Hcy)水平及亚甲基四氢叶酸还原酶(MTHFR)、甲硫氨酸合成酶还原酶(MTRR)基因多态性与不明原因复发性流产的相关性。方法以84例复发性自然流产的患者作为病例组,60例已有1次正常生育史,且既往无不良孕产史的妇女作为对照组,应用荧光定量PCR技术检测MTHFR基因C677T、A1298C和MTRR A66G位点的多态性,同时应用比色法检测血清Hcy水平。比较病例组和对照组间各种基因型和血清Hcy水平的差异。结果病例组血清Hcy水平明显高于对照组;高Hcy是先兆流产的危险因素(OR=2.132,P=0.021);MTHFR C677位点TT基因型携带者血清Hcy水平明显高于其他基因型;A1298位点CC基因型携带者血清Hcy水平明显高于AA野生型;MTRR A66位点GG基因型携带者血清Hcy水平明显高于其他基因型,差异均有统计学意义(P0.05)。结论 Hcy升高是导致复发性流产的重要危险因素;MTHFR基因C677T、A1298C和MTRR A66G位点的多态性改变均可致血清Hcy水平升高,与复发性流产的发生有一定的相关性。     

MTHFR基因C677T多态性与Down综合征发生的相关研究

目的研究亚甲基四氢叶酸还原酶(MTHFR)基因C677T多态性与Down综合征关系。方法采用聚合酶链反应—限制性片段长度多态性(PCR-RFLP)法对32例DS患儿母亲,70例未生育DS患儿女性MTHFR的C677T进行基因分析。比较上述各组基因型和等位基因频率分布有无差异。结果MTHFR基因C677T突变型等位基因(T)频率在实验组和对照组中有显著性差异,CC、TT基因型频率分布差异有显著性(P<0.05)。CT基因型比CC基因型生育DS患儿风险高2.84倍,TT基因型比CC基因型生育DS患儿风险高9.26倍。结论MTHFRC677T基因多态性与Down综合征发生相关,TT基因型增加了Down综合征的发生风险,CC基因型是降低Down综合征发生的保护性因素。     

Extramedullary Relapse of Acute Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation: Different Characteristics between Acute Myelogenous Leukemia and Acute Lymphoblastic Leukemia

Extramedullary relapse (EMR) of acute leukemia (AL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a contributor to post-transplantation mortality and remains poorly understood, especially the different characteristics of EMR in patients with acute myelogenous leukemia (AML) and those with acute lymphoblastic leukemia (ALL). To investigate the incidence, risk factors, and clinical outcomes of EMR for AML and ALL, we performed a retrospective analysis of 362 patients with AL who underwent allo-HSCT at the First affiliated Hospital of Soochow University between January 2001 and March 2012. Compared with patients with AML, those with ALL had a higher incidence of EMR (12.9% versus 4.6%; P = .009). The most common site of EMR was the central nervous system, especially in the ALL group. Multivariate analyses identified the leading risk factors for EMR in the patients with AML as advanced disease status at HSCT, hyperleukocytosis at diagnosis, history of extramedullary leukemia before HSCT, and a total body irradiation–based conditioning regimen, and the top risk factors for EMR in the patients with ALL as hyperleukocytosis at diagnosis, adverse cytogenetics, and transfusion of peripheral blood stem cells. The prognosis for EMR of AL is poor, and treatment options are very limited; however, the estimated 3-year overall survival (OS) was significantly lower in patients with AML compared with those with ALL (0 versus 18.5%; P = .000). The characteristics of post–allo-HSCT EMR differed between the patients with AML and those with ALL, possibly suggesting different pathogenetic mechanisms for EMR of AML and EMR of ALL after allo-HSCT; further investigation is needed.     

102例急性白血病患者焦虑、抑郁调查

目的　探讨急性白血病患者的焦虑和抑郁情绪。方法　采用焦虑自评量表 ( SAS)和抑郁自评量表 ( SDS)对急性白血病病人和健康人进行对照研究。结果　急性白血病患者 SAS和 SDS评分均明显高于健康对照组 ( P<0 .0 1 )。结论　急性白血病患者多伴焦虑和抑郁情绪。临床上在治疗该病同时 ,应给予心理疏导 ,必要时加用抗抑郁剂治疗。     

Fine-needle aspiration cytology of metastatic breast tumor originating from leukemia.

Two cases of metastatic breast tumor originating from leukemia are reported. Fine-needle aspiration (FNA) specimens showed a large number of isolated small-to-medium-sized atypical lymphocytic cells. It is difficult to distinguish metastatic breast tumors and primary breast cancers by physical findings alone. FNA cytology is an effective method for qualitative diagnosis. When atypical lymphocytic cells are obtained in aspiration materials of the breast, past history and general examination are necessary for diagnosis. In some cases of leukemia with breast involvement, good outcomes are obtained. Therefore, earlier detection is necessary in order to begin suitable therapy earlier and to avoid unnecessary excisional biopsy in patients with leukemia and breast tumors. To achieve this it is also necessary to first take into consideration the possibility of metastasis or infiltration of leukemia, and second to prepare two types of specimen for Papanicolaou stain and Giemsa stain before operation.     

Myeloablative Cord Blood Transplantation in Adults with Acute Leukemia: Comparison of Two Different Transplant Platforms

We compared the clinical outcomes of adults with acute leukemia that received single-unit umbilical cord blood transplantation (sUCBT) after conditioning with a busulfan/antithymocyte globulin (BU-ATG)–based regimen at University Hospital La Fe (n = 102) or double-unit UCBT (dUCBT) after conditioning with a total body irradiation (TBI)–based regimen at the University of Minnesota (n = 91). Nonrelapse mortality, relapse and disease-free survival were similar in the 2 groups. Multivariate analyses, showed more rapid neutrophil (hazard ratio [HR], .6; 95% confidence interval [CI], .45 to .80; P = .0006) and platelet recovery (HR, .59; 95% CI, .43 to.83; P = .002) after the BU-ATG-based conditioning and sUCBT. Although there was a lower risk of acute graft-versus-host disease (GVHD) grade II to IV (HR, 2.81; 95% CI, 1.75 to 4.35; P < .001) after BU-ATG and sUCBT, the incidences of grade III to IV acute and chronic GVHD were similar between the 2 groups. Regarding disease-specific outcomes, disease-free survival in both acute myeloid leukemia and acute lymphoblastic leukemia (ALL) patients were not significantly different; however, a significantly lower relapse rate was found in patients with ALL treated with TBI and dUCBT (HR, .3; 95% CI, .12 to .84; P = .02). In the context of these specific treatment platforms, our study demonstrates that sUCB and dUCBT offer similar outcomes.     

急性早幼粒细胞白血病中CD117和CD34共表达的临床意义

目的：研究CD117和CD34在成人急性非淋巴细胞自血病（Acute nonlymphoblastic leukemia，ANLL）M1～M2型和急性早幼粒细胞白血病（Acute promyelocytic leukemia，arE）M3患者中的表达，重点探讨M3患者CD117和CD34共表达（CD117／CD34共表达）的临床意义。方法：将研究病例分为M1～M2和M3二组，采用流式细胞术（Flow cytometery，FCM）随机检测54例M3和63例M1～M2二组初诊患者骨髓单个核细胞（BMMNC）髓系抗原CD117和干（祖）细胞抗原CD34的表达；比较M1～M2和M3二组ANLL患者中CD117、CD34表达的阳性率的差异，以及CD13、CD33和CD117分别与CD34共表达的阳性率差异。结果：CD117在M1～M2组患者中表达的阳性率是71．4／％（45／63），在M3组表达的阳性率为66．7％（36／54），差异无统计学意义（P=0．58）；CD34在M1～M2和M3二组中表达的阳性率分别为66．7％（42／63）和11．1％（6／54），差异有统计学意义（P=0．000）；二组ANLL的CD117／CD34共表达阳性率分别为71．1％（45／63）和7．4％（4／54），其差异有统计学意义（P=0．000）。结论：CD117可作为AL的髓系免疫学标志，但其在ANLL中的表达缺乏系列内阶段特异性。M3患者的CD34表达和CD117／CD34共表达的阳性率低于M1～M2者；CD117／CD34共表达可作为M1～M2和M3鉴别诊断的免疫学分型参考指标。     

Bone marrow transplantation for acute leukemia in second or subsequent remission

Summary Twenty-one patients with acute leukemia in second to fifth remission were treated with bone marrow transplantation: 19 patients with transplants from HLA-matched siblings and two with transplants from identical twins. Twelve patients survived from 15 to 1,625 days after transplantation: six of 11 in the ALL group and six of 10 in the AML group. Recurrence of leukemia after marrow transplantation occurred in five patients. The cause of death in five patients was infection, in two patients combined with graft-versushost disease. Long-term disease-free survival can probably be achieved in 30%–35% of all patients with acute leukemia who receive a marrow transplant in second or subsequent remission.Abbreviations AHTCG Anti-Human-T-Cell-Globulin - ALL Acute lymphoblastic leukemia - AML Acute myeloblastic leukemia - BMT Bone marrow transplantation - CMV Cytomegalyvirus - CSA Cyclosporin A - GVHD Graft versus host disease - KJ Karnofsky Index Dedicated to Prof. Dr. Dr. h.c. H.E. Bock on the occasion of his 80th birthday     

急性髓细胞白血病患者CD56抗原表达与MDR1基因表达量的关系研究

目的 研究初治急性髓细胞白血病(AML)患者CD56抗原表达与多药耐药(MDR)1基因表达量的关系,探讨CD56抗原表达与MDR1基因表达量在AML耐药中的作用及相互关系.方法 采用流式细胞术(FCM)和建立实时荧光定量PCR技术分别检测79例AML患者CD56抗原表达及MDR1基因表达水平并分析两者之间的关系及临床意义.结果 24.1%AML患者表达CD56抗原,FAB亚型中M5 AML患者表达阳性率高于其他亚型.遗传学危险度分级高危组患者CD56抗原表达阳性率显著高于中危组(P<0.01),伴t(8:21)AML患者CD56抗原表达阳性率(57.1%)显著高于其他低危组AML(P<0.05).CD56抗原表达阳性初治AML患者MDR1基因表达水平显著高于表达阴性患者(P<0.001).MDR1基因高表达且CD56抗原阳性AML组的CR率(58.8%)显著低于MDR1基因低表达且CD56表达阴性组(89.2%,P<0.01).结论 AML患者CD56抗原表达与MDR1基因表达水平存在相关性;同时定量检测MDR1基因表达及CD56抗原表达更有助于判断预后.     

Cytodiagnosis and monitoring of acute lymphocytic leukemia and eosinophilia in cerebrospinal fluid

A case of adult aleukemic leukemia with an isolated CNS relapse diagnosed by cytologic examination of the CSF is reported. CSF hypereosinophilia of uncertain significance was documented. Immunologic marker studies (CALLA, HTA, Tdt) were performed on the CSF and showed a null cell acute lymphocytic leukemia. Sequential CSF specimens were obtained to determine the continued presence of lymphoblasts. Cytologic monitoring of the CSF in acute leukemia is a useful technique to determine disease status and efficacy of therapy. We advocate the use of cell morphology for monitoring, reserving the use of cell markers for initial identification of malignant cells and for use when the cell morphology is altered.