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目的探讨急性髓系白血病(AML)患者MDR1和Nrf2基因表达水平及其临床意义。方法选择2011年10月至2014年1月南方医科大学南方医院血液科110例初治AML患者,其中男性66例,女性44例;年龄14~77岁,中位年龄36岁。通过实时荧光定量聚合酶链反应(PCR)方法联合检测患者MDR1和Nrf2基因的表达水平,分析其表达水平与疾病特征及临床疗效之间的关系。结果以110例初治AML患者MDR1和Nrf2基因表达量的中位数为分界点,将患者分别分为MDR1基因低表达组和MDR1基因高表达组及Nrf2基因低表达组和Nrf2基因高表达组各55例,而初治AML患者MDR1和Nrf2基因表达水平在不同分层的年龄、性别、法国(France)、美国(American)和英国(Britain)(FAB)分型、外周血象、骨髓原始细胞比例、遗传学危险度分层、免疫分型CD34表达间差异无统计学意义(P>0.05)。MDR1基因低表达组完全缓解(CR)率和总生存(OS)率均显著高于MDR1基因高表达组(P=0.032、0.045),而Nrf2基因低表达组和Nrf2基因高表达组CR率和OS率差异无统计学意义(P>0.05)。在MDR1基因低表达组患者中Nrf2基因表达水平高、低两组患者CR率及OS率差异均无统计学意义(P>0.05)。但在MDR1基因高表达组患者中Nrf2基因高表达组患者CR率和OS率皆优于Nrf2基因低表达组患者(P=0.007和P=0.001)。结论 MDR1基因是AML预后差的指标之一,Nrf2基因不同表达水平患者的危险度分层、疗效、预后差异均无统计学意义;但在MDR1基因高表达组患者中Nrf2基因高表达可能是预后好的指标。
Objective To investigate the expression of MDR1 and Nrf2 gene in patients with acute myeloid leukemia (AML) and its clinical significance. Methods A total of 110 newly diagnosed AML patients from Nanfang Hospital, Southern Medical University from October 2011 to January 2014 were retrospectively analyzed. Among them, 66 males and 44 females, aged from 14 to 77 years, with a median age of 36 years. The expression of MDR1 and Nrf2 genes were detected by real-time fluorescence quantitative polymerase chain reaction (PCR), and their relationship with disease characteristics and clinical efficacy was analyzed. Results The median of MDR1 and Nrf2 gene expression in 110 newly diagnosed AML patients was used as the cut-off point. The patients were divided into MDR1 low expression group, MDR1 high expression group, Nrf2 low expression group and Nrf2 high expression group Each of 55 cases. However, the expression of MDR1 and Nrf2 in newly diagnosed AML patients were different in age, sex, France, American and Britain (FAB) typing, peripheral blood, bone marrow blast cells There was no significant difference in proportion, genetic risk stratification and immunophenotype CD34 expression (P> 0.05). The rates of complete remission (CR) and overall survival (OS) in MDR1 low expression group were significantly higher than those in MDR1 high expression group (P = 0.032,0.045), while the CR rates of Nrf2 low expression group and Nrf2 high expression group were OS rate difference was not statistically significant (P> 0.05). There was no significant difference in CR rate and OS rate between patients with low expression of MDR1 and those with low expression of Nrf2 (P> 0.05). However, patients with high expression of MDR1 had higher CR rate and OS rate than patients with low expression of Nrf2 (P = 0.007 and P = 0.001). Conclusion The MDR1 gene is one of the indicators of poor prognosis in AML patients. The risk stratification, curative effect and prognosis of patients with different expression levels of Nrf2 gene were not statistically significant. However, the high expression of Nrf2 gene in patients with high expression of MDR1 gene may be the prognosis Good indicator.