流式细胞术检测急性白血病P-糖蛋白、多药耐药相关蛋白及bcl-2的临床意义

目的 研究急性白血病(AL)患者的P-糖蛋白(p170)、多药耐药相关蛋白(MRP)及bcl-2三种相关蛋白的表达情况,探讨其在AL患者多药耐药中的作用及相互关系.方法 AL患者44例,其中急性非淋巴细胞白血病(ANLL)29例,急性淋巴细胞白血病(ALL)15例,采用不同的化疗方案分别进行2个疗程的标准剂量化疗,按照治疗效果分为完全缓解(CR)组和诱导缓解失败(NR)组.选用12例同期就诊的健康人及良性血液病患者为对照,采用流式细胞术分别测定其p170、MRP、bcl-2的表达情况.结果 AL患者p170、MRP、bcl-2蛋白的表达均显著高于健康对照组,差异有统计学意义(P＜0.05).p170和MRP表达在各型白血病中CR组均低于NR组;NR组24例中22例至少有一或二种蛋白表达增高,且表达具有一定的一致性(P＜0.01).bcl-2的高表达与治疗反应差有关,CR组患者的bcl-2表达明显低于NR组(P＜0.05).结论 p170、MRP、bcl-2均与AL多药耐药的发生有关,是导致预后不良的重要因素.提示bcl-2导致耐药的机制不同于经典的p170途径.

Clinical significance of p170, bcl-2, MRP by flow cytometry in acute leukemia

Objective To explore the role of p170, MRP, bcl-2 in clinical drug- resistance and their correlation. Methods There are 44 acute leukemia(AL) patients, among them ANLL is 29, ALL is 15.The expression of p170, MRP, bcl-2 were detected. At last, the patients were divided into two groups: CR and NR according to efficacy after two periods standard chemotherapy. Results Overexpression of p170, MRP,bcl-2 were found in AL (P ＜0.05). The expression of p170 and MRP were lower in CR group than that in NR groups in AML and ALL; there were 22 of 24 patients expressed one or two proteins in NR groups and the expression of p170 in patients was concordant with that of MRP to certain extent (P ＜0.01). The overexpression of bcl-2 was related with the worse prognosis. The expression of bcl-2 was lower significantly in CR group than in CR and NR (P＜0.05). Conclusion p170, bcl-2, MRP are all associated with clinical MDR. High expression of these proteins is an unfavorable factor to prognosis. The expression of MRP and p170 showed coincidence, but showed no significance with expression of bcl-2 in untreated patients, it indicated that the drug-resistance mediated by p170 was different from bcl-2.