本文選題：CD146　切入點(diǎn)：急性B淋巴細(xì)胞白血病　出處：《鄭州大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：背景與目的急性B淋巴細(xì)胞白血病(acute B cell lymphoblastic leukemia B-ALL)是一種起源于造血干細(xì)胞的,以原始及幼稚淋巴細(xì)胞克隆性增殖為主的惡性疾病,是嚴(yán)重危害人類(lèi)的一種常見(jiàn)的造血系統(tǒng)惡性疾病。急性淋巴細(xì)胞白血病在兒童急性白血病中占80%,而在成人中僅占25%;經(jīng)規(guī)范化療等相關(guān)治療后兒童長(zhǎng)期無(wú)病生存率可達(dá)80%左右,而成人只有30%-40%。已有研究表明,在B-ALL中,患者的免疫分型中細(xì)胞表面抗原表達(dá)、分子生物學(xué)及細(xì)胞遺傳學(xué)的改變等相關(guān)危險(xiǎn)分層影響患者預(yù)后,在兒童與成人存在一定差異性,可能與患者不同預(yù)后存在較大關(guān)系。CD146屬于免疫蛋白家族中一員,是一種黏附分子,現(xiàn)已證實(shí)可在黑色素瘤、胰腺癌、乳腺癌等多種實(shí)體瘤中異常高表達(dá),且與腫瘤的進(jìn)展及轉(zhuǎn)移存在密切關(guān)系,是預(yù)后不良的指標(biāo)之一;已有研究表明CD146在30%左右的急性白血病異常高表達(dá),其中在B-ALL中表達(dá)率較高。本研究采用流式細(xì)胞學(xué)檢測(cè)CD146在成人組與兒童組表達(dá)的差異性,及分析異常高表達(dá)與低表達(dá)CD146的臨床特征、1個(gè)療程誘導(dǎo)緩解治療后的緩解率,CD146與其他抗原之間的的相關(guān)性。材料與方法收集2016年2月至2016年6月于鄭州大學(xué)第一附屬醫(yī)院血液科與兒科的初診為B-ALL(包括初診為慢性粒細(xì)胞白血病急淋變)的新鮮骨髓液或外周血標(biāo)本:共收集成人組(年齡≥14歲)24例,其中男12例,女12例,中位年齡35(14-66歲)歲;兒童組(年齡14歲)44例,其中男27例,女17例,中位年齡3(2月-13歲)歲。應(yīng)用流式細(xì)胞儀檢測(cè)CD146在兒童(44例)與成人(24例)B-ALL中的表達(dá)情況,并分別在成人組與兒童組分析CD146異常高表達(dá)與低表達(dá)在性別、初診時(shí)外周血血象、骨髓原始+幼稚淋巴細(xì)胞比例的臨床特征的關(guān)系,以及在分子生物學(xué)及細(xì)胞遺傳學(xué)中的關(guān)系,比較CD146異常高表達(dá)與低表達(dá)或不表達(dá)的1個(gè)療程化療后的緩解率,比較CD146與其他抗原之間的相關(guān)性。結(jié)果1.成人B-ALL中CD146表達(dá)率為29.17%(7/24),兒童B-ALL中CD146異常高表達(dá)率為9.09%(4/44),成人組的表達(dá)顯著高于兒童組(P0.05);2.成人組,CD146的表達(dá)與CD64(r=0.491,P=0.013)、CD117(r=0.578,P=0.03)的表達(dá)呈正相關(guān)關(guān)系,兒童組CD146的表達(dá)與CD71(r=0.419,P=0.005)、CD58(r=0.301,P=0.047)呈的表達(dá)正相關(guān)關(guān)系,無(wú)論是在成人組還是兒童組CD146異常表達(dá)均與預(yù)后較差的抗原表達(dá)相關(guān);3.經(jīng)1個(gè)正規(guī)誘導(dǎo)化療后,成人組CD146表達(dá)組緩解率明顯低于不表達(dá)CD146組,兒童組CD146表達(dá)組緩解率明顯低于CD146不表達(dá)組;4.CD146在無(wú)論在成人組還是在兒童組,CD146的高表達(dá)與分子生物學(xué)及細(xì)胞遺傳學(xué)無(wú)明顯差異。結(jié)論1.CD146在部分成人中異常表達(dá),成人組中CD46表達(dá)率較兒童組中高;2.CD146異常表達(dá)患者達(dá)CR低,可能作為評(píng)價(jià)近期療效預(yù)后不良的指標(biāo)。
[Abstract]:Background & objective Acute B cell lymphoblastic leukemia B-ALL (acute B cell lymphoblastic B-ALL) is a malignant disease which originated from hematopoietic stem cells and was mainly composed of primary and immature lymphocyte clonal proliferation. Acute lymphoblastic leukemia (ALL) accounts for 80% of acute leukemia in children, but only 25% in adults. The long-term disease-free survival rate of children after standardized chemotherapy and other related treatments can reach about 80%. In B-ALL, the risk stratification of cell surface antigen expression, molecular biology and cytogenetic changes in patients with B-ALL has been shown to influence the prognosis of patients, and there are some differences between children and adults. CD146 may be a member of the immune protein family, which has been proved to be highly expressed in melanoma, pancreatic cancer, breast cancer and other solid tumors. And it is closely related to the progression and metastasis of the tumor and is one of the indicators of poor prognosis. Some studies have shown that the expression of CD146 in acute leukemia is abnormally high in 30% or so. In this study, flow cytometry was used to detect the difference of CD146 expression between adults and children. To analyze the clinical characteristics of abnormal high expression and low expression CD146, and the correlation between CD146 and other antigens after a course of induction remission therapy. Materials and methods collected from February 2016 to June 2016 at Zhengzhou University. Fresh bone marrow fluid or peripheral blood samples from hematology departments and pediatrics of affiliated hospitals who were first diagnosed as B-ALL (including acute lymphoblastic changes in chronic myelocytic leukemia): 24 adult patients (age 鈮，

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