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目的:研究成人急性髓系白血病(AML)患者ETS相关基因(ERG)的表达水平及其与临床预后的相关性。方法:构建实时荧光定量检测ERG基因表达的PCR技术,定量检测123例初治成人AML患者骨髓ERG基因的表达水平并分析其与临床疗效及预后的关系。结果:初治AML组ERG基因表达显著高于正常对照组(P<0.01),初治AML患者ERG基因表达的水平与外周血原始幼稚细胞比例成正相关(P<0.05),而与血清LDH水平、外周WBC、Hb水平、PLT、骨髓原始幼稚细胞比例无明显相关性(P>0.05)。尽管在全部初治AML患者中ERG基因高表达组的完全缓解(CR)率(66.7%)与低表达组(80.0%)比较差异无统计学意义(P>0.05),但在正常核型初治AML患者中,ERG基因高表达AML患者的CR率显著低于ERG低表达组(55.6%vs86.5%,P<0.05)。对105例AML患者进行随访(中位随访时间490d)发现,正常核型AML中ERG高表达组总生存率(OS)显著低于ERG低表达组(33.3%vs 64.3%,P<0.05)。结论:ERG基因高表达很可能是正常核型AML一个重要的预后不良因素;检测初治AML患者ERG基因的表达水平有助于判定预后,指导分层治疗。
Objective: To investigate the expression of ETS related gene (ERG) in adult patients with acute myeloid leukemia (AML) and its relationship with clinical prognosis. Methods: The real-time fluorescent quantitative detection of ERG gene expression PCR technology to detect 123 cases of newly diagnosed adult AML patients with bone marrow ERG gene expression levels and analyze its relationship with clinical efficacy and prognosis. Results: The ERG gene expression in newly diagnosed AML group was significantly higher than that in normal control group (P <0.01). The expression of ERG gene in newly diagnosed AML patients was positively correlated with the proportion of primitive blasts in peripheral blood (P <0.05) , Peripheral WBC, Hb level, PLT, the proportion of primitive bone marrow naive cells (P> 0.05). Although the complete remission (CR) rate (66.7%) was not significantly different from that in the low expression group (80.0%) in all newly diagnosed AML patients, Among patients with AML, the CR rate of patients with ERG gene highly expressed AML was significantly lower than that of patients with low ERG expression (55.6% vs 86.5%, P <0.05). A total of 105 patients with AML were followed up for a median follow-up of 490 days. The overall survival rate (ER) in ERK-overexpressing normal AML was significantly lower than that in ERG-overexpressing (33.3% vs 64.3%, P <0.05). Conclusion: The high expression of ERG gene may be an important prognostic factor for normal karyotype AML. Detecting the expression of ERG gene in the newly diagnosed AML patients may help to determine the prognosis and guide the stratified treatment.