儿童急性淋巴细胞性白血病细胞凋亡与临床相关性研究

①目的　探讨急性淋巴细胞性白血病病儿细胞凋亡与临床分型及预后的关系。②方法　采用AO EB荧光染料双染法 ,检测 30例初治急性淋巴细胞性白血病 (ALL)病儿治疗前后不同时期骨髓单个核细胞凋亡指数 (AI)。③结果　ALL病儿治疗前AI明显低于正常对照组 (t=5 .4 17,P <0 .0 1) ,标危型治疗前AI高于高危型(t=5 .0 0 2 ,P <0 .0 1)。治疗前AI与外周血WBC呈负相关 (r =- 0 .6 32 ,P <0 .0 1) ;泼尼松及诱导缓解治疗后 ,随着细胞凋亡水平的升高 ,WBC逐渐下降 ,标危型组WBC下降明显 (t=3.14 8,P <0 .0 1) ;标危型病儿经诱导缓解期治疗完全缓解率高 (P =0 .0 0 2 5 ) ;随机动态观察标危型及高危型ALL病儿各 5例 ,高危型病儿 3例出现中枢神经系统白血病 ,2例骨髓复发 ,而 5例标危型骨髓检查为持续完全缓解 ,并且无髓外浸润表现。④结论　细胞凋亡可作为评价化疗反应及预后的参考指标之一。

A STUDY OF APOPTOSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA IN CHILDREN

Objective\ To study the relationship between apoptosis and clinical typing, and prognosis for acute lymphoblastic leukemia in children.\ Methods\ Apoptotic index (AI) by AO/EB apoptosis fluorescence assay (AFS) was carried out in 30 children with acute lymphoblastic leukemia(ALL) at different stage before and after the treatment.\ Results\ The AI of ALL children was lower than that of normal controls( t=5.417,P <0.01).Pre reatment AI of standard risk cases was higher than that of high risk cases( t=5.002,P <0.01).AI increased after prednisone and induction therapy. Pre reatment AI of ALL children was negatively associated with peripheral blood WBC( r=-0.632,P <0.01). WBC decreased with the increase of AI after the treatment, and WBC of standard risk cases decreased more significantly than that of high risk cases ( t=3.148,P <0.01). The complete remission rate was higher in standard risk cases than that in high risk cases. 5 standard risk cases and 5 high risk cases were followed up. 3 cases had central nerve system invasion and 2 had bone marrow relapse for high risk group, while 5 cases of standard risk were in complete remission without any signs of bone marrow invasion.\ Conclusion\ Apoptosis may be used as a reference parameter for evaluation of chemotherapeutic response and prognosis of ALL.