本文選題：CD146　切入點：急性B淋巴細胞白血病　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景與目的急性B淋巴細胞白血病(acute B cell lymphoblastic leukemia B-ALL)是一種起源于造血干細胞的,以原始及幼稚淋巴細胞克隆性增殖為主的惡性疾病,是嚴重危害人類的一種常見的造血系統(tǒng)惡性疾病。急性淋巴細胞白血病在兒童急性白血病中占80%,而在成人中僅占25%;經規(guī)范化療等相關治療后兒童長期無病生存率可達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胞表面抗原表達、分子生物學及細胞遺傳學的改變等相關危險分層影響患者預后,在兒童與成人存在一定差異性,可能與患者不同預后存在較大關系。CD146屬于免疫蛋白家族中一員,是一種黏附分子,現(xiàn)已證實可在黑色素瘤、胰腺癌、乳腺癌等多種實體瘤中異常高表達,且與腫瘤的進展及轉移存在密切關系,是預后不良的指標之一;已有研究表明CD146在30%左右的急性白血病異常高表達,其中在B-ALL中表達率較高。本研究采用流式細胞學檢測CD146在成人組與兒童組表達的差異性,及分析異常高表達與低表達CD146的臨床特征、1個療程誘導緩解治療后的緩解率,CD146與其他抗原之間的的相關性。材料與方法收集2016年2月至2016年6月于鄭州大學第一附屬醫(yī)院血液科與兒科的初診為B-ALL(包括初診為慢性粒細胞白血病急淋變)的新鮮骨髓液或外周血標本: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。應用流式細胞儀檢測CD146在兒童(44例)與成人(24例)B-ALL中的表達情況,并分別在成人組與兒童組分析CD146異常高表達與低表達在性別、初診時外周血血象、骨髓原始+幼稚淋巴細胞比例的臨床特征的關系,以及在分子生物學及細胞遺傳學中的關系,比較CD146異常高表達與低表達或不表達的1個療程化療后的緩解率,比較CD146與其他抗原之間的相關性。結果1.成人B-ALL中CD146表達率為29.17%(7/24),兒童B-ALL中CD146異常高表達率為9.09%(4/44),成人組的表達顯著高于兒童組(P0.05);2.成人組,CD146的表達與CD64(r=0.491,P=0.013)、CD117(r=0.578,P=0.03)的表達呈正相關關系,兒童組CD146的表達與CD71(r=0.419,P=0.005)、CD58(r=0.301,P=0.047)呈的表達正相關關系,無論是在成人組還是兒童組CD146異常表達均與預后較差的抗原表達相關;3.經1個正規(guī)誘導化療后,成人組CD146表達組緩解率明顯低于不表達CD146組,兒童組CD146表達組緩解率明顯低于CD146不表達組;4.CD146在無論在成人組還是在兒童組,CD146的高表達與分子生物學及細胞遺傳學無明顯差異。結論1.CD146在部分成人中異常表達,成人組中CD46表達率較兒童組中高;2.CD146異常表達患者達CR低,可能作為評價近期療效預后不良的指標。
[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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