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目的:探讨联合检测初治急性髓系白血病(AML)组织多药耐药基因1(MDR1)及脑和急性白血病胞质(BAALC)的表达量以及在预后判断中的作用。方法:荧光定量PCR检测并分析160例初治AML组织MDR1和BAALC基因的表达量及其与临床疗效和预后的关系。结果:初治AML组织MDR1和BAALC基因表达水平呈正相关性,P<0.001。MDR1高表达的AML患者同低表达组相比完全缓解(CR)率低,复发率高,总生存率低,P值均<0.05;而BAALC高低表达的差异均无统计学意义。MDR1和BAALC均低表达组疗效及预后最好,均高表达组最差。MDR1和BAALC均低表达组和MDR1低表达且BAALC高表达组的CR率均显著高于均高表达组,P值分别为0.004和0.034;前2组复发率(21.6%和25.9%)也显著低于后者(56.0%),P值分别为0.006和0.029;而均低表达组总生存率(62.2%)也显著高于均高表达组(28.3%)和MDR1高表达且BAALC低表达组(38.2%),P值分别为0.002和0.048。结论:MDR1高表达对初治AML患者的预后意义高于BAALC基因,只要检测到MDR1基因的高表达,无论BAALC高表达或者低表达,均提示较差的预后。联合检测初治AML患者MDR1和BAALC基因表达水平可进一步提高预测价值。
Objective: To explore the combined detection of multidrug resistance gene 1 (MDR1) and the expression of brain and acute leukemia cytoplasm (BAALC) in primary acute myeloid leukemia (AML) and its role in prognosis. Methods: Fluorescent quantitative PCR was used to detect and analyze the expression of MDR1 and BAALC in 160 newly diagnosed AML patients and its relationship with clinical efficacy and prognosis. Results: The expression of MDR1 and BAALC in newly diagnosed AML tissues was positively correlated (P <0.001). The AML patients with high expression of MDR1 had lower complete remission (CR) rate, higher recurrence rate and lower overall survival rate than those with low expression level (all P <0.05). However, there was no significant difference in the expression of BAALC between the two groups. MDR1 and BAALC were low expression group curative effect and the best prognosis, the highest expression group was the worst. The CR rates of both MDR1 and BAALC low expression group and MDR1 low expression group and BAALC high expression group were significantly higher than those of the high expression group (P = 0.004 and 0.034, respectively). The recurrence rates (21.6% and 25.9% (56.0%), the P values were 0.006 and 0.029, respectively. The overall survival rate in low expression group (62.2%) was also significantly higher than that in high expression group (28.3%) and high expression of MDR1 in BAALC low expression group (38.2%) with P values of 0.002 and 0.048, respectively. Conclusion: The high expression of MDR1 has a higher prognostic significance in patients with newly diagnosed AML than in patients with BAALC. As long as the high expression of MDR1 gene is detected, both high and low expression of BAALC suggest poor prognosis. Combined detection of MDR1 and BAALC gene expression in newly diagnosed AML patients may further enhance the predictive value.