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目的探讨在儿童急性淋巴细胞性白血病(ALL)患儿中进行胞浆糖皮质激素受体(GR)检测及其与治疗效果的相关性,探讨GR能否作为判断儿童ALL预后的因素。方法利用GR的单克隆抗体,通过流式细胞仪检测48例初治ALL患儿的骨髓液(起病时和疾病获缓解时)和15例随机长期持续缓解(CCR)状态下ALL患儿骨髓液及30例正常儿童外周血液单个核细胞胞浆GR表达水平,分析其与疾病疗效的关系。并对前期实验组进行临床追踪,分析前期实验数据与CCR或复发的关系。结果初发ALL患儿起病时GR与治疗后是否获得缓解(CR)无相关性(P=0.56);起病时GR表达水平与CR时GR表达水平无统计学差异(P=0.10);与疾病缓解时的骨髓微小残留病(MRD)指标无相关性(P=0.54)。患儿CR时其GR与正常对照组GR表达水平无统计学差异(P=0.21)。对前期实验组追踪结果显示,起病时GR表达水平与CCR或疾病复发不存在统计学差异(P=0.45);15例CCR患儿GR表达水平,与正常对照组比较,二者无统计学差异(P=0.28)。结论ALL患儿起病时其基础水平胞浆GR表达与治疗后缓解率、缓解时MRD水平、疾病长期持续缓解或复发无相关性,不能作为独立判断疾病的预后因素。而ALL患儿缓解及长期持续缓解时其胞浆GR与正常儿童GR表达水平无差异,故动态监测胞浆GR表达水平意义不大。
Objective To investigate the detection of cytoplasmic glucocorticoid receptor (GR) in children with acute lymphoblastic leukemia (ALL) and its relationship with the therapeutic effect. To investigate whether GR can be used as a prognostic factor in children with ALL. Methods Monoclonal antibody of GR was used to detect the bone marrow of 48 children with ALL (onset and disease relief) and 15 children with ALL with chronic long-term sustained response (CCR) by flow cytometry Fluid and peripheral blood mononuclear cells in 30 normal children. The relationship between the expression of GR and the curative effect of the disease was analyzed. And the clinical trial of the former experimental group to analyze the relationship between experimental data and CCR or recurrence. Results There was no correlation between GR at initial onset and CR after treatment (P = 0.56). There was no significant difference in the expression of GR between onset GR and GR (P = 0.10). There was no association with MRD markers at disease remission (P = 0.54). GR in children with CR and normal control group GR expression was no significant difference (P = 0.21). The results of the previous experimental group showed that there was no significant difference in the expression level of GR between onset and onset of CCR or disease recurrence (P = 0.45). The GR expression level in 15 CCR children was not statistically different from the normal control group Difference (P = 0.28). CONCLUSIONS: The basal levels of cytoplasmic GR expression in ALL children with onset are not correlated with post-treatment remission rate, MRD level at remission, persistent long-term remission or relapse of disease, and can not be used as independent prognostic factors. However, there was no difference in the expression of GR between cytoplasmic GR and normal children in ALL with long-term remission and long-term remission. Therefore, it is not meaningful to dynamically monitor the level of GR expression in cytoplasm.