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目的探讨定量监测儿童急性淋巴细胞白血病（ＡＬＬ）微量残留病（ＭＲＤ）细胞ＤＮＡ变化的临床意义。方法采用５′端修饰引物，构建内参照竞争模板，建立竞争性聚合酶链反应（ｃｏｍｐｅｔｉｔｉｖｅｐｏｌｙｍｅｒａｓｅｃｈａｉｎｒｅａｃｔｉｏｎ，ＣＰＣＲ）ＤＮＡ（ＣＰＣＲＤＮＡ）定量法，对７０例ＡＬＬ患儿进行了Ｔ细胞受体（Ｔｃｅｌｒｅｃｅｐｔｏｒ，ＴＣＲ）Ｖδ２Ｄδ３基因重排定性检测及完全缓解（ＣＲ）期ＭＲＤ的动态定量研究。结果（１）ＴＣＲＶδ２Ｄδ３基因重排检出率：在７０例ＡＬＬ中占８１％，４８例ＢＡＬＬ中占８３％，４例ＴＡＬＬ中占１／４，后两者比较差异有显著意义（Ｐ＜００５）。（２）ＭＲＤＤＮＡ定量监测显示：①随ＣＲ期延长（除ＣＲ＜３个月者），ＭＲＤ水平呈逐年下降趋势，以ＣＲ４～１２个月ＭＲＤ水平最高，并与骨髓复发呈正相关。②９例复发者于复发前平均７个月即出现ＭＲＤ增高，分子水平的改变先于临床复发。③ＡＬＬ持续完全缓解（ＣＣＲ）３年以上，ＭＲＤ持续转阴或持续≤００５％，可作为终止化疗的可靠指标。结论（１）建立了一种简捷、敏感、准确的ＣＰＣＲＤＮＡ定量法；（２）用该ＣＰＣＲ方法定量监测ＭＲＤ变化，对判断?
Objective To investigate the clinical significance of quantitative monitoring of DNA changes in children with acute microcytic leukemia (MRD). Methods Totally 70 children with ALL were enrolled in this study. T-cell receptor (T-1) was detected by using 5 ’end modified primers to construct an internal reference competitive template and CPCR DNA competitive assay (CPCR-DNA) qualitative detection of Vδ2δδδ gene rearrangement and dynamic quantitative analysis of MRD during complete remission (CR). Results (1) The detection rate of TCRVδ2δδδ gene rearrangement was 81% in 70 cases of ALL, 83% of 48 cases of ALL, 4 cases of T-ALL in 4 cases, the difference was significant (P <005). (2) MRD-DNA quantitative monitoring showed that: ① With the extension of CR period (except for CR <3 months), the MRD level showed a declining trend year by year. The MRD level was the highest at CR4 ~ 12 months and was positively correlated with bone marrow recurrence. ②9 cases of recurrence in an average of 7 months before recurrence MRD increased, the molecular level changes prior to clinical recurrence. ③ For patients with persistent complete remission (CCR) over 3 years, MRD continued to be negative or continued to be ≤005%, which could be used as a reliable indicator of termination of chemotherapy. Conclusion (1) The establishment of a simple, sensitive and accurate method of CPCR DNA quantification; (2) using the CPCR method to quantitatively monitor changes in MRD, to determine?