儿童急性淋巴细胞白血病中期因子表达的临床研究

目的:检测儿童急性淋巴细胞白血病(ALL)患者中期因子(MK)的表达,探讨MK在儿童ALL发病中的意义.方法:应用实时定量PCR(real-time PCR),对124例进展期和缓解期ALL患者、15例正常儿童骨髓标本进行MK mRNA的检测.根据患者初治时外周血白细胞数、年龄、免疫分型及皮质激素预治疗反应等因素把进展期患者分为标危组、中危组和高危组.结果:进展期、缓解期及正常对照组之间MK水平比较差异有统计学意义(P < 0.01).MK mRNA在B-ALL亚型中表达显著高于T-ALL亚型及正常对照(均P < 0.01),而T-ALL与正常对照之间MK mRNA的表达差异无统计学意义(P > 0.05).在ALL危险度各分层中,标危组和中危组的MK表达水平明显高于高危组(P < 0.01 或P < 0.05),标危组与中危组之间差异无统计学意义(P = 0.32).MK表达水平与患儿年龄、性别、血浆乳酸脱氢酶等未显示出相关性(均P > 0.05).高白细胞组(WBC ≥ 25×10~9/L)MK的表达较白细胞不增高组(WBC < 25×10~9/L)明显降低(P < 0.05).结论:MK表达增高在儿童ALL中可能为预后良好的指标.

The Clinical Study on Expression of Midkine Gene in Childhood Acute Lymphoblastic Leukemia

Objective: To investigate the expression of midkine (MK) gene in childhood acute lymphoblastic leukemia (ALL) and the clinical significance of MK thereof. Methods: The real-time PCR was used to assay MK gene expression in bone marrow of 15 normal children and 124 childhood ALL patients, including 73 patients in progression and 51 patients in complete remission. Three stratifications of progressing patients were established by prognostic factors such as white blood cell count, age, immunopherotype and response to the 7-day prednisolone prephase. Results: The significant statistic difference in MK gene expression was found between the progression group, the complete remission group and the normal group (P< 0.01). The MK gene expression was over-expressed in B-ALL than that in normal group. Furthermore, there was statistic difference between B-ALL and T-ALL (P< 0.01). But there was no difference in MK mRNA expression between the normal control and T-ALL. The assay in risk stratifications showed that the levels of MK gene were higher in standard risk group and mid-risk group than that in high risk group (P< 0.01 and P< 0.05, respectively). There was no significant difference between standard risk group and mid -risk group (P = 0.32). No correlations were found between MK level and age, gender or lactate dehydrogenase level in serum. The expression of MK was significantly lower in the group with higher white blood cells(WBC≥ 25×10~9/L) than that with lower WBC (WBC<25×l0~9/L) in peripheral blood (P< 0.05). Conclusion: The high level of MK was a favorable prognostic factor in childhood acute lymphoblastic leukemia patients.