急性髓样白血病干细胞CD200的表达及与疗效的相关分析

目的探究急性髓样白血病（AML）患者白血病干细胞（LSCs）中CD200的表达以及其与临床疗效的相关性。 方法收集2014年4月至2017年4月衢州市人民医院收治的137例AML患者，进行AML分型，分为M1~M5型。并对患者临床疗效进行统计，分为三组：完全缓解（CR）组（59例）、部分缓解（PR）组（47例）和未缓解（NR）组（31例）。通过流式细胞仪分离患者治疗前后的骨髓LSCs，检测LSCs表达、CD200在LSCs中的表达水平。 结果24.82%（34/137）AML患者的LSCs中表达CD200，且CD200在AML各亚型中表达的阳性占比的比较，差异有统计学意义（5/11、13/26、4/35、3/22、9/43，χ²=16.533，P=0.002）。AML-LSCs在AML各亚型中都存在高表达，且差异无统计学意义（F=0.980，P=0.421）；除CD200在M3组的LSCs中呈现更低表达外[（10.1 ± 2.7）%]，其在AML其他各亚型中表达差异均无统计学意义[（16.5 ± 2.8）%、（19.7 ± 4.0）%、（16.4 ± 2.4）%、（17.0 ± 3.1）%，P均> 0.05]。而在治疗疗效观察中，治疗前CD200在LSCs中的表达水平在CR、PR、NR三组间比较，差异均无统计学意义（P均> 0.05）；治疗后随着症状的缓解程度提高，各组CD200在LSCs中表达水平也随之降低[（16.4 ± 3.6）%、（10.8 ± 2.6）%、（5.0 ± 1.8）%，P均< 0.05]。治疗后，CR与NR两组CD200阳性表达占比的比较，差异有统计学意义（5/59 vs. 14/31，P < 0.017）；同时AML亚型分组中M3组内的CR、PR、NR三组CD200⁺/CD200^-分布情况的比较，差异有统计学意义（0/22、1/11、1/0，χ²=17.786，P < 0.001）。 结论AML患者LSCs中高表达CD200与不良预后有一定关系，可影响临床疗效。

Expression of CD200 in acute myeloid leukemia stem cells and its correlation with clinical efficacy

ObjectiveTo investigate the expression of CD200 in leukemia stem cells (LSCs) from the patients with acute myeloid leukemia (AML) and its correlation with clinical efficacy. MethodsA total of 137 AML patients admitted to Quzhou People's Hospital from April 2014 to April 2017 were collected and divided into M1-M5 types, according to AML classification. Based on the clinical efficacy, AML patients were also statistically divided into three groups: complete remission (CR) group (n=59), partial remission (PR) group (n=47) and non-remission (NR) group (n=31). The flow cytometry was used for separating bone marrow LSCs and detecting the expressions of LSCs and CD200 in LSCs before and after treatment. Results24.82% (34/137) AML patients had CD200 expression in LSCs, while the positive proportions of CD200 expression in each subtype of AML were significantly different (5/11, 13/26, 4/35, 3/22, 9/43; χ²=16.533, P=0.002). AML-LSCs had high expressions in all AML subtypes, which showed no significant difference (F=0.980, P=0.421); except that the expression of CD200 in the LSCs was obviously lower in the M3 group [(10.1 + 2.7)%], the CD200 expressions were no difference in the other AML subtypes [(16.5 ± 2.8)%, (19.7 ± 4.0)%, (16.4 ± 2.4)%, (17.0 ± 3.1)%, all P > 0.05]. The treatment effect observation showed that the expressions of CD200 in the LSCs were not statistically significantly different among CR, PR and NR groups before treatment (all P > 0.05); the expression of CD200 in the LSCs decreased with the improvement of symptoms after treatment [(16.4 ± 3.6)%, (10.8 ± 2.6)%, (5.0 ± 1.8)%, all P < 0.05]. There was a significant difference of CD200 positive expression between CR and NR groups after treatment (5/59 vs. 14/31, P < 0.017); in addition, the comparison of CD200⁺/CD200^- in CR, PR, NR subgroups of AML M3 group was significantly different (0/22, 1/11, 1/0; χ²=17.786, P < 0.001). ConclusionThe high expression of CD200 in LSCs of AML patients has a certain relationship with poor prognosis, which can affect the clinical efficacy.