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目的探讨染色体核型分析在慢性粒细胞白血病(CML)病程中的动态变化及意义。方法采用骨髓直接法和短期培养法制备染色体,应用R显带技术对92例CML患者进行动态染色体核型分析。结果 92例患者初诊时均为Ph染色体阳性(Ph+),在监测过程中,有18例(19.7%)患者发生核型演变,出现了额外的染色体。慢性期、加速期和急变期患者出现新的染色体核型异常的发生率分别为2.9%(2/69)、50.0%(1/2)和71.4%(15/21)。8例急变期病人进行了积极化疗,其中2例附加单纯的结构或数目的患者获得完全缓解(CR),附加3条以上染色体复杂异常的6例患者只有1例获得CR,3例无效,2例在半年内死亡。结论 Ph+CML出现额外染色体异常,提示病情进展,尤其是附加的染色体越复杂,预后越差。在CML病程中密切监测染色体核型动态变化有助于临床疗效观察、预后判断及指导临床及时调整治疗。
Objective To investigate the dynamic changes of chromosome karyotypes in the course of chronic myeloid leukemia (CML) and its significance. Methods Chromosomes were prepared by direct method of bone marrow and short-term culture. Dynamic Karyotype analysis was performed on 92 CML patients by R-banding technique. Results All 92 patients were Ph chromosome positive at the time of first visit. During the surveillance, 18 patients (19.7%) developed karyotype with additional chromosomes. The incidence of new chromosomal abnormalities in patients with chronic phase, accelerated phase and acute phase were 2.9% (2/69), 50.0% (1/2) and 71.4% (15/21), respectively. Of the 8 patients who underwent aggressive chemoradiotherapy, 2 had complete remission (CR) with a simple structure or number of patients, 6 had CR with 3 or more chromosomal abnormalities, 3 had no effect, 2 Cases died within six months. Conclusion Ph + CML extra chromosomal abnormalities, suggesting the progression of the disease, especially the additional chromosomes more complicated, the prognosis worse. Closely monitoring the dynamic changes of karyotype in the course of CML is helpful to the observation of clinical curative effect, prognosis judgment and guiding clinical timely adjustment and treatment.