CD146在成人与儿童急性B淋巴细胞白血病的表达及意义

发布时间：2018-03-18 19:48

  本文选题：CD146　切入点：急性B淋巴细胞白血病　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的急性B淋巴细胞白血病(acute B cell lymphoblastic leukemia B-ALL)是一种起源于造血干细胞的,以原始及幼稚淋巴细胞克隆性增殖为主的恶性疾病,是严重危害人类的一种常见的造血系统恶性疾病。急性淋巴细胞白血病在儿童急性白血病中占80%,而在成人中仅占25%;经规范化疗等相关治疗后儿童长期无病生存率可达80%左右,而成人只有30%-40%。已有研究表明,在B-ALL中,患者的免疫分型中细胞表面抗原表达、分子生物学及细胞遗传学的改变等相关危险分层影响患者预后,在儿童与成人存在一定差异性,可能与患者不同预后存在较大关系。CD146属于免疫蛋白家族中一员,是一种黏附分子,现已证实可在黑色素瘤、胰腺癌、乳腺癌等多种实体瘤中异常高表达,且与肿瘤的进展及转移存在密切关系,是预后不良的指标之一;已有研究表明CD146在30%左右的急性白血病异常高表达,其中在B-ALL中表达率较高。本研究采用流式细胞学检测CD146在成人组与儿童组表达的差异性,及分析异常高表达与低表达CD146的临床特征、1个疗程诱导缓解治疗后的缓解率,CD146与其他抗原之间的的相关性。材料与方法收集2016年2月至2016年6月于郑州大学第一附属医院血液科与儿科的初诊为B-ALL(包括初诊为慢性粒细胞白血病急淋变)的新鲜骨髓液或外周血标本:共收集成人组(年龄≥14岁)24例,其中男12例,女12例,中位年龄35(14-66岁)岁;儿童组(年龄14岁)44例,其中男27例,女17例,中位年龄3(2月-13岁)岁。应用流式细胞仪检测CD146在儿童(44例)与成人(24例)B-ALL中的表达情况,并分别在成人组与儿童组分析CD146异常高表达与低表达在性别、初诊时外周血血象、骨髓原始+幼稚淋巴细胞比例的临床特征的关系,以及在分子生物学及细胞遗传学中的关系,比较CD146异常高表达与低表达或不表达的1个疗程化疗后的缓解率,比较CD146与其他抗原之间的相关性。结果1.成人B-ALL中CD146表达率为29.17%(7/24),儿童B-ALL中CD146异常高表达率为9.09%(4/44),成人组的表达显著高于儿童组(P0.05);2.成人组,CD146的表达与CD64(r=0.491,P=0.013)、CD117(r=0.578,P=0.03)的表达呈正相关关系,儿童组CD146的表达与CD71(r=0.419,P=0.005)、CD58(r=0.301,P=0.047)呈的表达正相关关系,无论是在成人组还是儿童组CD146异常表达均与预后较差的抗原表达相关;3.经1个正规诱导化疗后,成人组CD146表达组缓解率明显低于不表达CD146组,儿童组CD146表达组缓解率明显低于CD146不表达组;4.CD146在无论在成人组还是在儿童组,CD146的高表达与分子生物学及细胞遗传学无明显差异。结论1.CD146在部分成人中异常表达,成人组中CD46表达率较儿童组中高;2.CD146异常表达患者达CR低,可能作为评价近期疗效预后不良的指标。
[Abstract]:Background & objective Acute B cell lymphoblastic leukemia B-ALL (acute B cell lymphoblastic B-ALL) is a malignant disease which originated from hematopoietic stem cells and was mainly composed of primary and immature lymphocyte clonal proliferation. Acute lymphoblastic leukemia (ALL) accounts for 80% of acute leukemia in children, but only 25% in adults. The long-term disease-free survival rate of children after standardized chemotherapy and other related treatments can reach about 80%. In B-ALL, the risk stratification of cell surface antigen expression, molecular biology and cytogenetic changes in patients with B-ALL has been shown to influence the prognosis of patients, and there are some differences between children and adults. CD146 may be a member of the immune protein family, which has been proved to be highly expressed in melanoma, pancreatic cancer, breast cancer and other solid tumors. And it is closely related to the progression and metastasis of the tumor and is one of the indicators of poor prognosis. Some studies have shown that the expression of CD146 in acute leukemia is abnormally high in 30% or so. In this study, flow cytometry was used to detect the difference of CD146 expression between adults and children. To analyze the clinical characteristics of abnormal high expression and low expression CD146, and the correlation between CD146 and other antigens after a course of induction remission therapy. Materials and methods collected from February 2016 to June 2016 at Zhengzhou University. Fresh bone marrow fluid or peripheral blood samples from hematology departments and pediatrics of affiliated hospitals who were first diagnosed as B-ALL (including acute lymphoblastic changes in chronic myelocytic leukemia): 24 adult patients (age 鈮，

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