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①目的 探讨采用筑巢式聚合酶链反应（Ｎｅｓｔ－ＰＣＲ）等多项指标监测小儿急性白血病（ＡＬ）微量残留病（ＭＲＤ）的临床意义。②方法 对１５２ 例ＡＬ在形态学、免疫学和细胞遗传学（ＭＩＣ）分型诊断的基础上，结合Ｎｅｓｔ－ＰＣＲ，姐妹染色单体交换（ＳＣＥ）、染色体核型分析方法进行ＭＲＤ监测。③结果 对５８ 例急性淋巴细胞白血病（ＡＬＬ）进行了Ｔ细胞受体（ＴＣＲ）Ｖδ２Ｄδ３ 基因重排监测，其中８３％ 的Ｂ－ＡＬＬ和２５％ 的Ｔ－ＡＬＬ具有此基因重排，检测灵敏度为１０－ ５～１０－ ６ ．对４４ 例ＡＬＬ进行了ＭＲＤ动态监测，结果显示化疗期间ＰＣＲ由阴性转为阳性或持续阳性者，易引起骨髓复发、死亡。ＰＣＲ转阴时间有明显个体差异性。持续完全缓解３ 年以上的ＡＬＬ病儿ＰＣＲ持续阴性可作为停药治疗的可靠指标。对７６ 例ＡＬ进行了ＳＣＥ动态监测，结果表明ＳＣＥ频率变化与疾病的严重程度呈平行关系。对６１ 例ＡＬ进行了染色体核型动态监测，结果表明初发ＡＬ染色体核型正常者亦有ＤＮＡ 严重损伤。④结论 在ＭＩＣ分型诊断的基础上，采用Ｎｅｓｔ－ＰＣＲ，ＳＣＥ，染色体核型分析等多项指标进行ＡＬ的ＭＲＤ动态监测、综合分析评价，对指导治疗、预测复发及判断
(1) Objective To investigate the clinical significance of monitoring trace residual disease (MRD) in children with acute leukemia (AL) by using Nest-PCR and other indexes. Methods 152 cases of AL were diagnosed by morphology, immunology and cytogenetics (MIC) based on the combination of Nest-PCR, sister chromatid exchange (SCE), chromosome karyotype analysis method MRD monitoring. Results The rearrangement of T cell receptor (TCR) Vδ2Dδ3 gene was performed in 58 cases of acute lymphoblastic leukemia (ALL). 83% of B-ALL and 25% of T-ALL had this gene rearrangement. The detection sensitivity was 10-5 ~ 10-6. Forty-four ALL patients underwent MRD dynamic monitoring. The results showed that PCR negative to positive or persistent PCR during chemotherapy led to bone marrow recurrence and death. PCR negative time obvious individual differences. Persistent complete response to more than 3 years of ALL children with persistent persistent PCR can be used as a reliable indicator of treatment discontinuation. 76 cases of AL were SCE dynamic monitoring results show that the frequency of SCE and the severity of the disease was parallel. Chromosomal karyotypes were dynamically monitored in 61 cases of AL. The results showed that there was DNA damage in patients with normal AL karyotype. ④ Conclusion On the basis of MIC classification diagnosis, MRD dynamic monitoring of AL was performed by using Nest-PCR, SCE and chromosomal karyotyping, and comprehensive analysis and evaluation were conducted to guide the treatment, predict relapse and judge