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目的 探讨T细胞受体 (TCR)双基因标志定量检测法在儿童急性淋巴细胞白血病 (ALL)化疗效应动态定量评价中的意义。方法 建立TCR双基因的竞争性聚合酶链反应 (CPCR) DNA定量法 ,对 96例ALL进行微量残留病 (MRD)动态定量检测和化疗效应差异的定量评价。并对 5 6例急性粒细胞性白血病 (AML)进行了TCRγ基因重排的检测。结果 ① 96例ALL的TCRδ重排率为 81% ;TCRγ重排率为 76 % ;TCRδ和γ双基因重排率为 6 8% ;TCRδ或γ基因检测重排率为 88 5 %。B ALL的TCRδ重排检出率 (86 % )与T ALL(2 5 % )比较有显著性差异 (精确概率计算 ,P =0 0 16 )。② 5 6例AML组TCRγ重排率为 2 5 % ,而AML M5型其重排率达 5 4%。③检测 6 6例完全缓解 (CR)期ALL的 132份骨髓标本 ,化疗效应定量评价结果表明 :早期诱导缓解的化疗效应 ,对ALL患儿CR期MRD水平有重要影响 ,MRD水平与预后密切相关 ;CR 412个月ALL的MRD水平较高 ,显示该期化疗杀伤效应相对不足 ,是骨髓复发的危险时期 ;认为长期持续完全缓解 (CCR)达 3年以上的ALL ,若MRD持续转阴或维持低水平 (≤ 0 0 5 % ) ,则可作为停药指标。结论 TCRδ、γ双基因CPCR DNA定量法 ,可提高ALL基因重排检出率和MRD监测敏感性 ,能有效地进行大样本的化疗效应定量评价 ,有助于
Objective To investigate the significance of quantitative detection of T cell receptor (TCR) dual gene markers in the dynamic quantitative evaluation of chemotherapeutic effect in childhood acute lymphoblastic leukemia (ALL). Methods A quantitative polymerase chain reaction (CPCR) method was established for the quantitative analysis of the dynamic quantitative and chemotherapeutic effects of MRD in 96 patients with ALL. Fifty-six cases of acute myeloid leukemia (AML) were examined for TCRγ gene rearrangement. Results ① The TCRδ rearrangement rate was 81% in 96 ALL patients. The TCRγ rearrangement rate was 76%. The TCRδ and γ double gene rearrangement rate was 68%. The TCRδ or γ gene rearrangement rate was 88.5%. The detection rate of TCRδ rearrangement in B ALL patients (86%) was significantly different from T ALL (25%) (exact probability calculation, P = 0.0016). ② The TCRγ rearrangement rate of 25 AML patients was 25%, while that of AML M5 cells was 54%. ③ The detection of 132 bone marrow samples from 6 6 ALL patients with complete remission (CR) ALL showed that the chemotherapy effect of early induction of remission had a significant effect on the MRD level in CR patients, and the MRD level was closely related to the prognosis ; CR had a higher MRD level at 412 months in ALL, which indicated that the chemotherapy-killing effect was relatively insufficient in this period, which was a dangerous period of bone marrow recurrence; ALL with long-term sustained complete remission (CCR) of more than 3 years was considered as negative if MRD continued to negative or maintained Low level (≤ 0 0 5%), it can be used as a stop drug index. Conclusion TCRδ, γ dual gene CPCR DNA quantification method can improve the detection rate of ALL gene rearrangement and the sensitivity of MRD monitoring, and can effectively evaluate the chemotherapeutic effect of large samples and contribute to