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目的 探讨急性淋巴细胞白血病 (简称急淋 ,ALL)微小残留病 (MRD)与肿瘤多药耐药基因mdr1 mRNA表达的关系。方法 选择本院住院及门诊的ALL患儿 33例 ,采集初治前及完全缓解 (CR)后不同时期的骨髓标本 2ml,提取DNA及RNA。用聚合酶链反应 (PCR)法扩增T细胞受体γ链 (TCRγ)单克隆性基因重排 ,以确定MRD的存在 ;同时采用反转录聚合酶链反应 (RT PCR)方法对同一份标本进行mdr1 mRNA表达的检测 ,将具有阳性特异性条带的电泳胶片用GQS 960图像处理系统软件进行定量分析 ,计算mdr1与 β2 MG的比值 ,以mdr1 / β2 MG比值≥ 0 3定为阳性表达。CR后按时进行强化治疗 ,每隔 3～ 6个月对MRDDNA及mdr1 mRNA作动态观察。结果 (1 ) 33例ALL患儿初诊时TCRγ单克隆性基因重排阳性率为 82 % (2 7/ 33) ,完全缓解 (CR)率为 91 % (30 / 33) ,CR时MRD阳性率为 80 % (2 4 / 30 )。 (2 )随访观察 6～ 1 8个月MRD阳性率呈逐渐下降趋势 ,而mdr1 mRNA阳性表达率呈逐渐上升趋势。 (3)根据随访结果 ,将处于CR期的 2 8例患儿分为 4个组 :MRD及mdr1均阳性组 (1组 ) 7例ALL患儿有 6例复发 ;MRD及mdr1均阴性组 (4组 )ALL复发数为 0 ;MRD阳性而mdr1阴性组 (2组 ) ,8例中有 2例复发 ;MRD阴性而mdr1阳性组 (3组 ) 4例中有 1例复发
Objective To investigate the relationship between minimal residual disease (MRD) of acute lymphoblastic leukemia (abbreviated as acute lymphoblastic leukemia, ALL) and mdr1 mRNA expression of tumor multidrug resistance gene. Methods Thirty-three children with ALL were enrolled in our hospital and outpatients. Two milliliters of bone marrow samples were collected before treatment and after complete remission (CR). DNA and RNA were extracted. Polymerase chain reaction (PCR) was used to amplify the TCR gamma chain (TCRγ) monoclonal gene rearrangement to determine the presence of MRD; simultaneously, reverse transcription polymerase chain reaction (RT PCR) was used for the same copy. Specimens were tested for mdr1 mRNA expression, and electrophoresis films with positive specific bands were quantified using the GQS 960 image processing system software. The ratio of mdr1 to β2 MG was calculated, and the ratio of mdr1 / β2 MG ≥ 0.3 was considered as positive expression. . After intensive treatment with CR, the MRDDNA and mdr1 mRNA were observed dynamically every 3 to 6 months. Results (1) The positive rate of TCRγ monoclonal gene rearrangement was 82% (27/33) and the complete remission (CR) rate was 91% (30/33) at the time of initial diagnosis in 33 children with ALL. It is 80% (24/30). (2) Follow-up observation The MRD positive rate showed a decreasing trend from 6 to 18 months, while the mdr1 mRNA positive expression rate showed a gradually increasing trend. (3) According to the follow-up results, 28 patients in CR stage were divided into 4 groups: MRD and mdr1 positive group (group 1) 7 cases of ALL children with recurrence of 6; MRD and mdr1 negative group ( Group 4) ALL had a recurrence of 0; MRD positive and mdr1 negative (group 2), and 8 of 8 patients relapsed; MRD negative and mdr1 positive (group 3) 1 of 4 patients relapsed