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目的探讨急性淋巴细胞性白血病(ALL)患儿诊断时胞质糖皮质激素受体(GR)表达水平与疗效的相关性,探讨GR能否作为判断儿童ALL预后的因素之一。方法2005年8月1日-2007年9月30日,本院利用GR单克隆抗体,通过流式细胞仪检测147例初治ALL患儿诊断时骨髓液单个核细胞GR表达水平,并进行临床资料追踪,应用SPSS 13.0软件分析GR表达水平与疾病各治疗阶段疗效的相关性。结果147例患儿治疗后缓解(CR)143例,12例复发。ALL患儿起病时GR表达水平与泼尼松窗口治疗结果是否敏感无相关性(F=1.769 P=0.174);与诱导治疗第19天骨髓检查结果无相关性(F=0.411 P=0.664);与诱导治疗结果是否获得疾病缓解无相关性(t=1.670 P=0.096);与疾病获得缓解时按微小残留病(MRD)水平分组无相关性(F=2.040 P=0.134);与临床随访中疾病处于缓解状态或复发无相关性(t=1.471 P=0.143);但与疾病治疗失败(诱导治疗不缓解和疾病复发)有相关性(t=2.128 P=0.035)。在随访时间超过1 a的75例患儿中(中位随访时间17个月),9例复发,患儿起病时GR表达水平与疾病的长期持续缓解或复发无相关性(t=1.848 P=0.069)。结论GR尚不能作为独立判断疾病预后的因素,但有可能作为指导治疗的指标之一。
Objective To investigate the correlation between the expression of cytoplasmic glucocorticoid receptor (GR) and therapeutic effect in children with acute lymphoblastic leukemia (ALL) and to investigate whether GR can be used as a prognostic factor in children with ALL. Methods From August 1, 2005 to September 30, 2007, GR monoclonal antibody was used in our hospital to detect GR expression of bone marrow mononuclear cells in 147 newly diagnosed ALL children by flow cytometry. Data tracking, the application of SPSS 13.0 software analysis of GR expression levels and the efficacy of various stages of disease correlation. Results After the treatment, 147 cases of children were relieved (CR) of 143 cases, 12 cases of recurrence. There was no correlation between the GR expression level and onset of prednisone window in patients with ALL (F = 1.769 P = 0.174), but no correlation with bone marrow test on the 19th day (F = 0.411 P = 0.664) (T = 1.670 P = 0.096); there was no correlation with the minimal residual disease (MRD) group when the disease was relieved (F = 2.040 P = 0.134); with clinical follow-up (T = 1.471 P = 0.143). However, it was associated with the failure of treatment of the disease (induction of remission and relapse of the disease) (t = 2.128 P = 0.035). Among the 75 children who were followed up for more than 1 year (median follow-up time of 17 months), 9 patients relapsed. There was no correlation between GR expression and long-term sustained remission or relapse (t = 1.848 P = 0.069). Conclusion GR can not be used as an independent factor to judge the prognosis of the disease, but it may be used as one of the indicators to guide the treatment.