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目的:探讨72例急性髓系白血病(acute myelogenous leukemia,AML)患者CD13表达及其与FLT3-ITD、NPM1突变同步检测的临床意义,并分析FLT3-ITD、NPM1突变的关系及其与CD13表达水平的相关性。方法:收集72例AML患者病例资料,采用流式细胞仪检测72例AML患者CD13表达,PCR及Sanger测序法检测FLT3-ITD、NPM1突变。结果:72例AML患者中68例CD13表达阳性(68/72,94.44%),经诱导化疗,44例获得完全缓解(44/68,64.71%)。CD13~+与CD13-患者相比,χ~2=2.118,P=0.148,完全缓解率差异无统计学意义(P>0.05)。68例CD13~+的AML患者中,FLT3-ITD~+/NPM1~+双突变患者白细胞计数明显高于其余3组,差异均有统计学意义(P=0.000、P=0.010、P=0.000),而完全缓解率明显低于FLT3-ITD~-/NPM1~+与FLT3-ITD~-/NPM1~-组,差异有统计学意义(χ~2=8.400,P=0.000;χ~2=8.880,P=0.000)。FLT3-ITD~+/NPM1~-患者中位生存期仅为24个月,较FLT3-ITD~-/NPM1~+与FLT3-ITD~-/NPM1~-患者,生存期更短。FLT3-ITD~-/NPM1~+患者的平均年龄、白细胞计数及血红蛋白均高于FLT3-ITD~+/NPM1~-患者(P=0.030;P=0.000;P=0.040),白细胞计数及血红蛋白均高于FLT3-ITD~-/NPM1~-患者(P=0.020;P=0.00),完全缓解为85.71%,明显高于FLT3-ITD~+/NPM1~+和FLT3-ITD~+/NPM1~-患者(χ2=8.40,P=0.000;χ2=13.45,P=0.000),中位生存期为41个月(95%CI=34.4~47.6个月),较FLT3-ITD~+/NPM1~+和FLT3-ITD~+/NPM1~-患者生存期长,提示NPM1突变患者预后良好。结论:68例CD13~+患者中,FLT3-ITD~+/NPM1~+双突变患者具有高白细胞数和低CR率;FLT3-ITD~+/NPM1~-患者生存期短;FLT3-ITD~-/NPM1~+患者诱导缓解率高,FLT3-ITD~+/NPM1~-较低。对于AML患者,提示可以同时分析CD13表达及FLT3-ITD和NPM1突变的情况,为AML的相关治疗提供一个更好的思路。
Objective: To investigate the clinical significance of CD13 expression in 72 patients with acute myelogenous leukemia (AML) and the simultaneous detection of FLT3-ITD and NPM1 mutations. The relationship between FLT3-ITD and NPM1 mutation and the expression of CD13 Relevance. Methods: The clinical data of 72 AML patients were collected. The expression of CD13 was detected by flow cytometry in 72 patients with AML. The FLT3-ITD and NPM1 mutations were detected by PCR and Sanger sequencing. Results: Of 72 AML patients, 68 were positive for CD13 (68/72, 94.44%). After induction chemotherapy, 44 patients achieved complete remission (44/68, 64.71%). There was no significant difference in complete remission rate between CD13 ~ + and CD13- patients (χ ~ 2 = 2.118, P = 0.148) (P> 0.05). The leukocyte count in FLT3-ITD ~ + / NPM1 ~ + double mutation group was significantly higher than that in the other three groups in 68 CD13 + AML patients (P = 0.000, P = 0.010, P = 0.000) , But the complete remission rate was significantly lower than that of FLT3-ITD ~ - / NPM1 ~ + and FLT3-ITD ~ - / NPM1 ~ - group (χ ~ 2 = 8.400, P = 0.000; , P = 0.000). Patients with FLT3-ITD ~ + / NPM1 ~ - had a median survival of 24 months, with shorter survival than those with FLT3-ITD ~ - / NPM1 ~ + and FLT3-ITD ~ - / NPM1 ~. The mean age, white blood cell count and hemoglobin in patients with FLT3-ITD ~ - / NPM1 ~ + were significantly higher than those in patients with FLT3-ITD ~ + / NPM1 ~ (P = 0.030; P = 0.000; The complete remission was 85.71%, which was significantly higher than that of FLT3-ITD ~ + / NPM1 ~ + and FLT3-ITD ~ + / NPM1 ~ - patients (P = 0.020; The median survival time was 41 months (95% CI 34.4 to 47.6 months), significantly higher than that of FLT3-ITD ~ + / NPM1 ~ + patients (χ2 = 8.40, P = 0.000; χ2 = 13.45, P = 0.000) FLT3-ITD ~ + / NPM1 ~ - patients with long survival, suggesting that patients with NPM1 mutation prognosis is good. CONCLUSIONS: FLT3-ITD ~ + / NPM1 ~ + double mutations in patients with FLT3-ITD ~ + / NPM1 ~ + have a high white blood cell count and low CR rate in 68 patients. FLT3-ITD ~ + / NPM1 ~ / NPM1 ~ + patients with high remission induction rate, FLT3-ITD ~ + / NPM1 ~ - lower. For patients with AML, suggesting that CD13 expression and FLT3-ITD and NPM1 mutations can be analyzed simultaneously, providing a better idea for the treatment of AML.