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目的监测成人急性淋巴细胞白血病(ALL)患者化疗过程中的血浆DNA水平,初步探讨其与ALL化疗疗效的关系。方法采集55例成人ALL患者化疗前及其中45例患者化疗一疗程后的静脉血,根据骨髓象、血象及临床体征进行疗效分组。以80名体检健康者作为对照。用磁珠法提取血浆DNA和内参照质粒DNA,双重荧光定量PCR技术进行DNA定量检测。结果 ALL患者化疗前血浆DNA含量[M(P25,P75)]为248.1(97.1,448.7)ng/mL,显著高于健康对照组19.1(12.7,25.8)ng/mL(Z=8.916,P<0.01);化疗一疗程后血浆DNA含量为35.5(17.7,83.0)ng/mL,显著低于化疗前水平(Z=6.322,P<0.01);不同疗效化疗前组血浆DNA水平有显著性差异(χ2=6.960,P<0.05),不同疗效组化疗后血浆DNA水平有显著性差异(χ2=11.145,P<0.01)。完全缓解组化疗前、后血浆DNA水平有显著性差异(Z=3.92,P<0.01),部分缓解组、未缓解组化疗前、后无显著性差异。生存曲线分析显示,化疗一疗程后血浆DNA水平<50 ng/mL的ALL患者生存率高于血浆DNA水平≥50 ng/mL的患者(χ2=3.860,P<0.05)。结论血浆DNA定量检测对ALL的化疗疗效评价及预后评估有重要意义。血浆DNA水平降低提示预后良好。
Objective To monitor the level of plasma DNA during the chemotherapy of adult patients with acute lymphoblastic leukemia (ALL) and to explore its relationship with the efficacy of chemotherapy. Methods Fifty-five adult patients with ALL were enrolled in the study. Before and after chemotherapy, 45 patients received venous blood after a course of chemotherapy. The patients were divided into three groups according to their bone marrow, blood and clinical signs. 80 healthy people as a control. The plasma DNA and internal reference plasmid DNA were extracted by magnetic beads method, and the quantitative DNA was detected by double fluorescence quantitative PCR. Results The plasma DNA level of ALL patients before chemotherapy was 248.1 (97.1, 448.7) ng / mL, which was significantly higher than that of healthy controls (12.7,25.8 ng / mL, Z = 8.916, P <0.01 ). After one course of chemotherapy, the plasma DNA content was 35.5 (17.7,83.0) ng / mL, which was significantly lower than that before chemotherapy (Z = 6.322, P <0.01). The plasma DNA levels were significantly different before chemotherapy = 6.960, P <0.05). There was a significant difference in plasma DNA levels after chemotherapy (χ2 = 11.145, P <0.01). There was a significant difference in plasma DNA levels between the complete remission group before and after chemotherapy (Z = 3.92, P <0.01). There was no significant difference between the partial remission group and the non-remission group before and after chemotherapy. Survival curves showed that ALL patients with plasma DNA levels <50 ng / mL after one cycle of chemotherapy had higher survival rates than those with plasma DNA levels ≥50 ng / mL (χ2 = 3.860, P <0.05). Conclusion The quantitative detection of plasma DNA is of great significance in the evaluation of chemotherapy efficacy and prognosis of ALL. Lower plasma DNA levels suggest a good prognosis.