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目的:探讨急性髓系白血病(AML)患者骨髓中WT1的表达及其与疗效和预后的相关性。方法:采用实时荧光定量PCR检测75例初诊AML患者(非APL)治疗各阶段骨髓WT1的拷贝数和内参因子(GADPH)的拷贝数,以NQ比值=WT1基因拷贝数/内参基因拷贝数计算WT1的表达水平,并对临床特征、诱导化疗后完全缓解(CR)率、2年总生存率(OS)及无事件生存率(EFS)进行了分析。结果:治疗前WT1的表达水平与年龄、性别、基因突变、FAB分型及预后分组等无明显相关性。治疗前WT1高表达患者的CR率为65.4%(17/26),低表达患者的CR率为93.9%(46/49),两组比较差异有统计学意义(χ~2=8.25,P=0.004);两组患者2年总生存与无事件生存率的差异均有统计学意义(P<0.05),高表达组OS及EFS率均低于低表达组;诱导化疗后约1个月、3个月及6个月时,WT1水平较初治时下降1个数量级以上的患者组,其两年总生存明显升高(P<0.05)。结论:骨髓WT1的表达水平可作为AML患者(非APL)疗效及预后评估的有效指标。
Objective: To investigate the expression of WT1 in the bone marrow of patients with acute myeloid leukemia (AML) and its relationship with efficacy and prognosis. Methods: The copy number of bone marrow WT1 and the copy number of internal control factor (GADPH) in 75 cases of newly diagnosed AML patients (non-APL) were detected by real-time fluorescence quantitative PCR. The ratio of WT1 The clinical features, complete remission (CR) rate, 2-year overall survival (OS) and event-free survival (EFS) after induction of chemotherapy were analyzed. Results: The expression of WT1 before treatment had no significant correlation with age, gender, gene mutation, FAB classification and prognosis group. The CR rate of patients with high expression of WT1 before treatment was 65.4% (17/26), while that of patients with low expression of TGF-β1 was 93.9% (46/49). There was significant difference between the two groups (χ ~ 2 = 8.25, P = 0.004). There were significant differences in the two-year overall survival and event-free survival between the two groups (P <0.05). The OS and EFS rates in the high expression group were lower than those in the low expression group. About 1 month after induction chemotherapy, At 3 months and 6 months, the WT1 levels decreased by more than 1 order of magnitude compared with those at the beginning of treatment, and their overall survival was significantly increased in two years (P <0.05). Conclusion: The expression of bone marrow WT1 can be used as an effective indicator of efficacy and prognosis in patients with AML (non-APL).