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目的探讨儿童急性白血病(AL)血浆基质细胞衍生因子-1(SDF-1)的水平和骨髓细胞表面CXCR4的表达及其临床意义。方法收集50例AL患儿、20例健康儿童和10例非恶性血液病患儿(对照组)。采用ELISA法分别检测AL患儿初诊时、缓解6个月、复发时和对照组儿童外周血浆SDF-1水平。用流式细胞仪检测50例AL患儿初诊时和10例非恶性血液病患儿骨髓细胞表面CXCR4的表达。结果1.AL初诊组和缓解组血浆SDF-1水平明显高于对照组(Pa<0.01),且初诊组高于缓解组(P<0.01);急性淋巴细胞白血病(ALL)组血浆SDF-1水平高于急性髓细胞白血病(AML)组(P<0.01);SDF-1水平在ALL和AML各亚型之间差异无统计学意义;复发的4例患儿,其血浆SDF-1水平在初诊时和复发时均高于缓解时(Pa<0.05);髓外浸润组SDF-1水平与非髓外浸润组比较差异无统计学意义(P>0.05)。2.AL患儿骨髓细胞表面CXCR4的相对荧光强度明显高于对照组(P<0.01);ALL组高于AML组(P<0.01);CXCR4在ALL的L1组与L2组的表达,无统计学差异,但T-ALL组高于B-ALL组(P<0.05);CXCR4在AML亚型中,M4+M5组高于M2组、M3组,M2组高于M3组,其差异有统计学意义(Pa<0.05);髓外浸润组明显高于非髓外浸润组(P<0.05)。3.初诊组血浆SDF-1水平和CXCR4的相对荧光强度呈正相关(P<0.05),二者均与外周血WBC计数呈正相关(Pa<0.05)。结论SDF-1和CXCR4在AL儿童呈高水平表达,可作为儿童AL的检测指标之一。动态检测SDF-1水平,有助于判断其病情发展和估计预后。CXCR4的高表达与髓外浸润和初诊时外周血WBC计数密切相关。
Objective To investigate the level of plasma stromal cell-derived factor-1 (SDF-1) and the expression of CXCR4 on bone marrow cells in children with acute leukemia and its clinical significance. Methods Fifty children with AL, 20 healthy children and 10 children with non-hematologic malignancies (control group) were collected. ELISA method was used to detect the level of SDF-1 in the peripheral blood of children with AL at 6 months, relapse and control group respectively. Flow cytometry was used to detect the expression of CXCR4 on the surface of myeloid cells in 50 AL children and 10 non-hematologic malignancies. Results 1. The level of plasma SDF-1 in the newly diagnosed and remissioned groups was significantly higher than that in the control group (P <0.01), and higher in the newly diagnosed group than in the remission group (P <0.01) (P <0.01). There was no significant difference in SDF-1 level between ALL and AML subtypes. In 4 relapsed children, the level of SDF-1 in plasma was significantly higher than that in AML There was no significant difference in SDF-1 level between the extramedullary infiltration group and non-extramedullary infiltration group (P> 0.05). The relative fluorescence intensity of CXCR4 on bone marrow cells in AL children was significantly higher than that in control group (P <0.01); the expression of CXCR4 in ALL group was higher than that in AML group (P <0.01) (P <0.05). In the AML subtypes, CXCR4 was higher in the M4 + M5 group than in the M2 group, while in the M3 group and M2 group, the difference was statistically significant Significance (P <0.05); extramedullary infiltration group was significantly higher than non-extramedullary infiltration group (P <0.05). There was a positive correlation between plasma SDF-1 level and CXCR4 relative fluorescence intensity (P <0.05). Both of them had a positive correlation with peripheral WBC count (P <0.05). Conclusion SDF-1 and CXCR4 are highly expressed in children with AL, which can be used as one of the indicators of AL in children. Dynamic detection of SDF-1 levels can help determine the progression of the disease and estimate the prognosis. The high expression of CXCR4 and extramedullary infiltration and peripheral blood WBC count is closely related.