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目的 检测骨髓增生异常综合征 (MDS)、急性白血病 (AL)和慢性髓性白血病 (CML)患者血清Ⅲ型前胶原 (PCⅢ )、Ⅳ型胶原 (Ⅳ·C)、层粘连蛋白 (LN)和透明质酸 (HA)的水平 ,探讨血清基质成分改变的临床意义。方法 放免法测定 2 6例健康者 ,11例MDS ,2 6例CML ,33例AL患者的PCⅢ、Ⅳ·C、LN和HA水平 ,其中 12例白血病检测骨髓和外周血上述指标 ,并进行临床分析。结果 与健康者相比 ,MDS者血清Ⅳ·C、HA、LN水平明显增高 (P <0 0 1或P <0 0 5 ) ,PCⅢ水平无差异 (P >0 0 5 ) ;AL者初诊时四项指标升高 (P <0 0 1或P <0 0 5 ) ;CML明显增高 (P均 <0 0 1) ,但慢性期与急变期无差异 (P >0 0 5 )。 12例白血病患者骨髓HA水平高于外周血 (P <0 0 5 ) ,PCⅢ、Ⅳ·C、LN的水平无差异 (P >0 0 5 )。AL化疗获CR后血清HA水平较初诊时下降 (P <0 0 5 ) ,PCⅢ、Ⅳ·C、LN水平无变化 (P >0 0 5 ) ;复发时血清HA水平比CR时上升 (P <0 0 1)并达初诊时水平 (P >0 0 5 )。结论 MDS、AL、CML患者均存在细胞外基质成分的异常 ,动态血清HA水平观测可一定程度反映AL化疗疗效 ,但无助于慢粒急变的预测。
Objective To detect the changes of serum levels of type Ⅲ procollagen (Ⅳ), laminin (LN) and type Ⅲ collagen in patients with myelodysplastic syndrome (MDS), acute leukemia (AL) and chronic myelogenous leukemia (CML) Hyaluronic acid (HA) levels, to explore the clinical significance of changes in serum matrix composition. Methods The levels of PCⅢ, Ⅳ · C, LN and HA in 26 healthy subjects, 11 patients with MDS, 26 patients with CML and 33 patients with AL were measured by radioimmunoassay. The above indexes were detected in 12 cases of leukemia by bone marrow and peripheral blood analysis. Results Serum levels of IV C, HA and LN in MDS were significantly higher than those in healthy controls (P <0.01 or P <0.05), but no difference in PCⅢ (P> 0.05) Four indexes were higher (P <0.01 or P <0.05); CML was significantly higher (P <0.01), but there was no difference between chronic phase and blastic phase (P> 0.05). The level of bone marrow HA in 12 leukemia patients was higher than that in peripheral blood (P <0.05). There was no difference in PCⅢ, Ⅳ · C and LN (P> 0.05). The level of serum HA in AL patients after CR was lower than that at first visit (P <0.05), and there was no change in PCⅢ, Ⅳ · C and LN (P> 0.05) 0 0 1) and reached the level of the first visit (P> 0.05). Conclusion The abnormalities of extracellular matrix components exist in both MDS, AL and CML patients. The observation of dynamic serum HA level may reflect the effect of AL chemotherapy to a certain degree, but it is not helpful for the prediction of acute mycelium blast crisis.