急性髓细胞白血病细胞CD34抗原表达的临床及生物学意义

为研究ＣＤ３４在急性髓细胞白血病（ＡＭＬ）中的临床及生物学意义，用流式细胞术检测了１０７例ＡＭＬＣＤ３４表达。结果显示４８．５％的患者ＣＤ３４阳性表达，Ｍ３（１５．８％）低于其他亚型（ｐ〈０．０５）。ＣＤ３４＾＋者肝脾肿大常见。ＣＤ３４表达在ｔ（８；２１）、正常核型及ｔ（１５；１７）组分别为７２．０％、４０?７％及１７．６％。ＣＤ３４＾＋者的完全缓解率（４１．９％）明显低于ＣＤ３４＾－者的５９．６     

c-kit在急性白血病中的表达及其临床意义

目的 :研究c kit受体 (c kitR ,CD1 1 7)在急性白血病 (AL)中的表达。重点了解c kitR表达对急性非淋巴细胞白血病 (ANLL)的诊断价值及其与ANLL的临床和生物学特征的关系。方法 :采用流式细胞术 (FCM)分别检测并比较 2 4例急性淋巴细胞白血病 (ALL)和 47例ANLL初诊患者骨髓单个核细胞 (MNC)跨膜c kitR表达的阳性率及阳性水平 ,并设立 1 0例正常人骨髓标本作为阴性对照组。结果 :ALL患者的c kitR表达的阳性率及阳性水平与正常人相比无显著性差异 (P >0 .0 5)。ANLL患者的c kitR表达率及阳性水平则均显著高于正常人和ALL患者(P均 <0 .0 1 )。c kitR阳性率以M1 、M2 最高 ,M4最低。ANLL患者c kitR表达与外周血白细胞计数、肝脾肿大无关(P >0 .0 5) ,但与染色体核型异常及LDH水平增高有关 (P均 <0 .0 5)。结论 :ANLL患者的c kitR阳性表达率及阳性水平均显著高于正常人和ALL患者 ,提示c kitR可作为AL患者MIC分型诊断的髓系免疫表型依据 ,可用以协助ANLL的诊断以及ANLL与ALL的鉴别诊断     

miRNA-150在不同类型急性白血病不同疾病状态患者血浆中的表达及临床意义

目的:探讨miRNA-150在不同类型急性白血病不同疾病状态患者血浆中的表达情况及意义。方法:选取急性白血病患者64例和正常对照组20例，抽取空腹静脉血，离心后取血浆，直接扩增目的miRNA，并反转录为cDNA，qRT-PCR方法检测血浆miRNA-150的表达。结果:急性白血病患者初诊组血浆miRNA-150的表达显著低于正常对照组和缓解组，初诊组与复发组之间无统计学差异，缓解组与正常对照组之间无统计学差异。同时miRNA-150在初诊组急性髓性白血病与急性淋巴细胞性白血病之间的表达无统计学差异。结论: 血浆miRNA-150在急性髓性白血病与急性淋巴细胞性白血病患者中表达降低，并且两种类型间比较无显著性差异，而在疾病不同阶段状态中的表达不同，有一定的诊断、治疗及预后评估意义。     

免疫球蛋白超家族分子CD54在各种恶性淋巴增殖性疾病的表达

目的　为了探讨免疫球蛋白超家族分子CD5 4(细胞间粘附分子 1)在恶性淋巴增殖性疾病的表达及其意义。方法　用免疫荧光方法检测 2 4例急性淋巴细胞白血病 (acutelymphoblasticleukemia ,ALL) ,15例多发性骨髓瘤 (multi plemyeloma ,MM) ,2 6例非霍杰金氏淋巴瘤 (non Hodgkinslymphoma ,NHL) ,4例慢性淋巴细胞白血病 (chroniclymphocyticleukemia ,CLL) ,4例霍杰金氏淋巴瘤 (Hodgkinslymphoma)及 16例正常人造血干细胞CD+ 3 4细胞表面CD5 4的表达。结果　( 1)除多发性骨髓瘤、霍杰金氏淋巴瘤外 ,非霍杰金氏淋巴瘤、慢性淋巴细胞白血病、急性淋巴细胞白血病细胞膜表面CD5 4表达低于正常造血细胞CD+ 3 4细胞 (分别为 12 .9± 5 .7%、10 .2± 2 .8%、11.2± 5 .8%VS47.7± 12 .1%)。 ( 2 )细胞间粘附分子 1与细胞类型有关 ,在T ALL表达明显低于B ALL表达。 ( 3) )细胞间粘附分子 1与非霍杰金氏淋巴瘤 (NHL)部分临床特征有相关性 ,有结外病变、骨髓浸润、Ⅳ期患者表达水平下降 (P <0 .0 5 )。结论　不同的恶性淋巴增殖性疾病粘附分子CD5 4的表达存在不同的改变并与NHL临床特征有关。     

CD117在急性白血病中的表达及其临床意义

 目的 探讨细胞表面抗原CD117在各型急性白血病（AL）中的表达规律及其临床意义。方法 采用流式细胞术（FCM）检测139例AL患者骨髓或外周血中CD117的表达情况,并进行分析和比较。结果 急性淋巴细胞白血病（ALL）患者CD117阳性细胞表达水平与正常对照组相比差异无统计学意义（P＞0.05）;急性髓细胞白血病（AML）患者CD117阳性患者比例及阳性细胞表达水平较正常对照组和ALL组均升高,差异有统计学意义（均P＜0.05）。在AML各亚型中,CD117阳性患者比例及阳性细胞表达水平以M0／M1最高,M5b最低;在5种髓系膜抗原标志中,虽然CD117检测AML的灵敏度低于CD13和CD33,但特异性都较高;CD117与CD34及HLA-DR在AML中的表达呈显著正相关,但在M3中,CD117表达明显高于CD34和HLA-DR。结论 CD117可作为AL患者MIC诊断分型的重要髓系免疫表型指征,在AML的诊断分型以及AML和ALL的鉴别诊断中具有重要意义。     

CD20在成年人急性B淋巴细胞白血病中的表达及其临床意义

 目的　检测CD20在成年人急性B淋巴细胞白血病（B-ALL）的表达,探讨其与临床特点的相关性。方法　回顾性总结分析96例成年B-ALL患者CD20表达情况,结合其临床特性和治疗转归进行分析。结果　96例成年B-ALL患者中,CD20阳性29例（30.20 %）,CD20阴性67例（69.79 %）。CD20阳性组与阴性组男女比分别为1.42∶1和1.79∶1（χ2＝0.27,P＞0.05）,中位年龄分别为28岁与23岁,肝脾及淋巴结浸润比例分别为44.83 %和41.38 %、40.30 %和35.82 %,髓系抗原表达比例分别为51.72 %与56.72 %,Ph染色体和bcr-abl融合基因阳性比例分别为24.14 %与28.36 %,4周内完全缓解率分别为73.08 %与68.85 %,差异均无统计学意义（P值均＞0.05）。在复发率和3年总体生存率上,CD20阳性组分别为54.55 %与14.80 %,CD20阴性组分别为29.63 %与37.30 %,两组间差异有统计学意义（χ2＝0.42,χ2＝5.31;P值均＜0.05）。结论　CD20在成年人B-ALL表达与临床特点无相关性,但对判断患者的预后有一定的指导意义。     

成人急性白血病强化治疗67例预后分析

目的：观察成人急性白血病（ＡＬ） 患者完全缓解（ＣＲ） 后强化治疗的效果。方法：对６７ 例ＣＲ后的成人ＡＬ患者进行强化治疗,急性髓细胞性白血病（ＡＭＬ）以中剂量阿糖胞苷（ＩＤ－ Ａｒａ－ Ｃ）方案为主,急性淋巴细胞性白血病（ＡＬＬ）以中剂量氨甲蝶呤（ＩＤ－ ＭＴＸ）方案为主。结果：４８ 例ＡＭＬ患者中位ＣＲ 期１６ 个月,预期３ 年和４ 年无病生存（ＤＦＳ）为３６９％ 和２１１ ％ ;２３ 例（４７９ ％） 患者复发。１９ 例ＡＬＬ 患者中位ＣＲ 期１４ 个月,预期４ 年ＤＦＳ 为３１５％ ;１０ 例（５２６％ ） 患者复发。结论：以ＩＤ－ Ａｒａ－ Ｃ 为主的强化方案及以ＩＤ－ ＭＴＸ 为主的强化方案分别能延长ＡＭＬ及ＡＬＬ患者的ＤＦＳ,降低复发率     

CD20在成年人急性B淋巴细胞白血病中的表达及其临床意义

Objective To explore the clinical significance of expression of the CD20 in 96 adults B-lineage acute lyrnphoblastic leukemia (B-ALL). Methods The CD20 expression of 96 acute lymphoblastic leukemia patients were determined by flow cytometry. The characteristics ,examination results and outcome were analyzed retrospectively. Results Out of the 96 patients, there were 29 (30.20 %) patients with CD20positive and 67 (69.79 %) patients with CD20 negative. The distribution of age, infiltration of liver, spleen, and lymphnodes, the expression of myeloid lineage marker, the incidence of Ph chromosome and bcr-abl fusion gene and the complete remission rate within 4 weeks between CD20 positive and negative groups showed no significant differences (P ＞ 0.05). The relapse rate and 3 year over survival rate of adults B-ALL in CD20 positive and negative groups were 54.55 % and 14.80 %, 29.63 % and 37.30 % respectively with a significant differences (x2 = 0.42, 5.31, P＜ 0.05). Conclusion The expression of CD20 in adult B-ALL appears to be not associated with clinical features and CD20 expression in adult B-ALL cells appears to be associated with poor prognosis.     

CD20在成年人急性B淋巴细胞白血病中的表达及其临床意义

Objective To explore the clinical significance of expression of the CD20 in 96 adults B-lineage acute lyrnphoblastic leukemia (B-ALL). Methods The CD20 expression of 96 acute lymphoblastic leukemia patients were determined by flow cytometry. The characteristics ,examination results and outcome were analyzed retrospectively. Results Out of the 96 patients, there were 29 (30.20 %) patients with CD20positive and 67 (69.79 %) patients with CD20 negative. The distribution of age, infiltration of liver, spleen, and lymphnodes, the expression of myeloid lineage marker, the incidence of Ph chromosome and bcr-abl fusion gene and the complete remission rate within 4 weeks between CD20 positive and negative groups showed no significant differences (P ＞ 0.05). The relapse rate and 3 year over survival rate of adults B-ALL in CD20 positive and negative groups were 54.55 % and 14.80 %, 29.63 % and 37.30 % respectively with a significant differences (x2 = 0.42, 5.31, P＜ 0.05). Conclusion The expression of CD20 in adult B-ALL appears to be not associated with clinical features and CD20 expression in adult B-ALL cells appears to be associated with poor prognosis.     

Polymeric nanoparticle-mediated silencing of CD44 receptor in CD34 acute myeloid leukemia cells

The adhesion receptor CD44 plays an important role in the survival and retention of leukemic stem/progenitor cells (LSPC) within the bone marrow (BM) niche, as well as in the high relapse rates of acute myeloid leukemia (AML). Down-regulating CD44 could be clinically relevant not only for suppression of the deregulated function of LSPC but also in LSPC response to chemotherapeutic agents. Small interfering RNA (siRNA) delivery is a promising approach for AML treatment, and we recently reported effective siRNA delivery into difficult-to-transfect AML cell lines using lipid-substituted polyethylenimine/siRNA complexes (polymeric nanoparticles). In this study, we investigated polymeric nanoparticle-mediated silencing of CD44 in CD34⁺ LSPC cell models (leukemic KG-1 and KG-1a cell lines) as well as primary AML cells. Polymeric nanoparticle-mediated silencing decreased surface CD44 levels in KG-1, KG-1a and primary AML cells by up to 27%, 30% and 20% at day 3, respectively. Moreover, CD44 silencing resulted in induction of apoptosis in KG-1 cells, reduced adhesion of KG-1 and KG-1a cells to hyaluronic acid-coated cell culture plates and BM-MSC, and decreased adhesion of primary AML cells to BM-MSC. Our results suggest that polymeric nanoparticle-mediated silencing of CD44 might be a useful technique for inhibiting LSPC interactions with their microenvironment, thereby prohibiting leukemia progression or sensitizing LSPC to chemotherapy.     

急性髓细胞性白血病细胞表面CD分子表达及临床意义研究

目的 探讨急性髓细胞性白血病(AML)细胞表面CD分子的表达情况.方法 采用CD45分子作为靶目标抗原,应用多参数流式细胞术检测300例AML患者细胞表面的CD分子,分析患者的免疫表型.结果以表达百分比﹥20%作为阳性,300例AML患者的CD抗原表达均不相同,cyt-MPO、CD33、CD117和CD38表达最强,为强阳性(80%~100%).以CD抗原表达>60%为阳性,结果显示:CD33、CD117、CD13、cyt-MPO四种抗原阳性表达的患者,阳性细胞所占的比例高于其他抗原,差异有统计学意义(P﹤0.05).CD15/CD64、CD15/CD33和CD33/CD64抗原的阳性表达比较,差异均有统计学意义(P﹤0.05);CD33/cyt-MPO抗原的阳性表达比较,差异无统计学意义(P﹥0.05).结论 AML细胞表面的CD抗原表达具有差异性,CD13、cyt-MPO、CD33、CD117呈高表达.CD分子在AML细胞中阳性表达的差异性可为治疗提供有价值的线索.     

CD56~ 急性髓系白血病血液学特征及其临床意义

目的 :研究CD5 6 急性髓系白血病 (AML)血液学特征及临床意义。方法 :流式细胞计数仪检测白血病细胞分化抗原的表达 ;RT PCR检测EBV mRNA ;电镜及免疫电镜观察超微结构 ;回顾性分析初诊时血液学特点、临床表现及对化疗的反应。结果 :CD5 6表达率为 30 .6 2 %(79 2 5 8) ;CD5 6 AML中未见EBV感染 ;电镜及免疫电镜发现CD5 6 AML细胞核中存在 1— 2团絮状结构 ;CD5 6的表达与年龄、性别、WBC、Hb、BPC、BM中白血病细胞数、CR率及CR期无关 (P值分别为 0 .12 8,0 .877,0 .181,0 .86 6 ,0 .6 2 9,0 .40 7,0 .998,0 .0 96 ) ;与较多的髓外侵润(77.78%对 6 1.11%,P =0 .0 19)、CD34表达 (6 6 .6 7%对 46 .48%,P =0 .0 3)、P170表达 (5 1.79%对 34 .94%,P =0 .0 48)及较短的生存期有关 (中位数 ,11.5个月对 18个月 ;P值 0 .0 478)。结论 :CD5 6 AML是一种特殊类型的白血病 ,预后较差 ,应进一步分型并针对性治疗。     

The clinical significance of soluble CD86 levels in patients with acute myeloid leukemia and myelodysplastic syndrome

BACKGROUND: Levels of the soluble form of CD86 (sCD86) are elevated in a proportion of patients with leukemia. Although it is a potential modulator of antitumor responses, the significance of sCD86 in patients with hematologic malignancies is unknown. METHODS: The authors evaluated sCD86 levels by enzyme-linked immunosorbent assay in patients with acute myeloid leukemia (AML) (n = 57 patients) and patients with myelodysplastic syndrome (MDS) (n = 40 patients) and analyzed the relation between sCD86 levels and various clinical parameters. RESULTS: Levels of sCD86 were elevated (> 2.32 ng/mL) relative to normal donors (0.22-2.32 ng/mL; n = 51 patients) in 25% of patients with AML and in 27% of patients with MDS. Patients with AML who had elevated sCD86 levels had significantly lower complete remission (CR) rates compared with patients with AML who had normal sCD86 levels. In multivariate analysis using sCD86 as a continuous variable and including the interaction of age and sCD86 as a variable, sCD86 was a significant prognostic factor (P = 0.014) independent of cytogenetics. Further analysis demonstrated that, in patients with AML age 60 years and younger, but not in patients older than 60 years, elevated sCD86 levels were associated with significantly shorter survival (P = 0.04). There was no correlation between sCD86 levels and CR rates or survival in patients with MDS. CONCLUSIONS: The presence in patients with AML of elevated levels of circulating sCD86 were associated with lower CR rates and poor survival. The prognostic significance of sCD86 was independent of cytogenetics but was modulated by age, in that it was independently significant only in younger patients. The results suggest that sCD86 may play a role in modulating immune responses associated with the progression of AML.     

Treatment of acute myeloid leukemia in the elderly: a clinical dilemma

Fifty-four patients representing all the cases of acute myeloid leukemia in patients aged over 60 years, presenting to three adjacent hospitals, were studied. Only 26 of the 54 patients were considered suitable for remission induction with intensive combination chemotherapy which produced seven complete remissions (CR) (26 per cent). Eighteen of the 54 patients survived longer than three months--11 of these had received remission induction chemotherapy (five CRs), two low dose cytarabine, one vincristine and vitamin A and four supportive treatment alone. By six months all the patients who had received supportive treatment had died. Patients who received intensive chemotherapy spent 77 per cent of the first 90 days in hospital and half died in hospital. Patients receiving differentiating agents or supportive care spent more time at home (37 per cent, 34 per cent of the first 90 days, respectively) but had shorter overall survival. Assessment of clinical characteristics in an attempt to predict response to treatment and survival indicated that poor performance status and the presence of infection were the most important factors. Analysis was limited by the statistically small number in the group. At present there is no reliable method of predicting which patients will respond well to treatment with intensive chemotherapy. The clinical dilemma is whether to treat more intensively to benefit a minority, or to use supportive treatment to allow more time to be spent at home albeit with a shorter overall survival.     

COX-2在急性髓细胞白血病中的表达和临床意义的初步研究

目的 探讨环氧化酶2（COX-2）基因在急性髓细胞白血病（AML）中的表达和意义及其对预后的影响。方法 采用Real time PCR检测AML患者中COX-2 mRNA的表达水平,分析COX-2表达水平与AML临床病理特征和预后的关系。采用Kaplan-Meier 法分析COX-2表达与总生存期（OS）的关系。结果 38例AML患者COX-2 mRNA相对表达量的均值为4.77±2.21,其中20例患者为COX 2高表达（8.33±1.96）,18例患者为低表达（1.89±1.04）。COX-2表达与初诊白细胞计数和初次治疗反应有关,与性别和年龄无关。COX-2高表达者的中位OS为16.2个月,低于低表达者的25.6个月（P=0.041）。结论 COX-2表达水平与AML患者的生存有关,其高表达可能是AML的不良预后因素。     

儿童急性白血病生存素和细胞周期素B1基因的表达

目的：探讨生存素、细胞周期素B1的表达与儿童急性白血病（AL）的关系。方法：采用RT—PCR法对初治或复发AL患儿42例和完全缓解AL（ALCR）患儿13例及非恶性疾病患儿15例骨髓单个核细胞进行基因生存素、细胞周期素B1表达的检测。结果：初治和复发AL组生存素mRNA表达水平分别为0．472和0．810；细胞周期素B1mRNA为0．609和0．739，均高于ALCR组和对照组（均为0）（P〈0．01）；复发AL组生存素mRNA表达水平高于初治组，差异有统计学意义（P=0．025）。生存素基因的表达与白细胞总数及临床分型有关，而与性别、年龄、免疫分型无明显相关性；细胞周期素B1表达与性别、年龄、免疫分型、白细胞总数及临床分型无明显相关关系。儿童AL中生存素与细胞周期素B1的表达呈正相关。生存素mRNA表达水平高者缓解率低。结论：儿童AL中存在生存素、细胞周期素B1异常表达，两者表达存在相关性。生存素是AL复发的高危因素；AL生存素高表达者可以降低AL的化疗敏感性，生存素水平对AL有判断疗效和预后的价值。     

小儿中枢神经系统白血病间歇性放射治疗的临床研究(附13例病例报道)

】　目的　以间歇性放射治疗＋鞘内注射方法治疗曾接受全颅、全脊髓放射治疗和(或)鞘内注射后中枢神经系统白血病(CNSL)复发的急性淋巴细胞性白血病(ALL)患儿,以便建立一种在达到治疗目的的前提下尽量减少第2次放射治疗引起的晚期并发症的放射治疗方案。方法　应用国产8 MV直线加速器,选择13例曾接受全颅、全脊髓放射治疗和(或)鞘内注射后CNSL复发的急性淋巴细胞性白血病患儿进行全颅、全脊髓间歇性放射治疗,并联合鞘内注射。治疗方案为全颅150 cGy/次＋全脊髓75 cGy/次,每日1次照射3天。第1天鞘内注射甲氨喋呤(MTX) 8～12 mg/m