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探索应用ＴＣＲｒ基因重排标志及改良的极限稀释定量ＰＣＲ法检测小儿ＡＬＬ微小残留病（ＭＲＤ）的可行性，探讨其追踪骨髓ＭＲＤ变化的临床意义。方法：改良极限稀释定量ＰＬＲ法。结果：敏感度平均为４拷贝。对１４例初治阳性病人在诱导达到缓解（ＣＲ）时的ＭＲＤ定量检测结果显示，骨髓复发组ＭＲＤ定量值平均为０．３４３％，未复发组为０．００４％（Ｐ＜０．０１）。１４例中６例ＣＲ时ＭＲＤ阴性，４例在追踪期内持续阴性，２例转为阳性（分别为０．０１７％、０．０２０％），化疗后ＭＲＤ渐减少至转阴；３例ＣＲ时ＭＲＤ平均值为０．０７７％，在缓解期ＭＲＤ值渐减少，其中２例临床持续缓解，１例骨髓无复发但发生睾丸白血病，１例ＣＲ时ＭＲＤ值较高，２例持续高值，２例ＭＲＤ值渐增高，此５例均复发。结论：ＣＲ时ＭＲＤ阳性的病人应持续监测其水平，若持续高值或逐渐增高，复发的可能性大，应加强化疗以防复发。采用极限稀释定量法检测ＡＬＬ的ＭＲＤ有简单、敏感性高的优点。
To explore the feasibility of using TCRr gene rearrangement markers and modified limit-dilution quantitative PCR to detect minimal residual disease (MRD) in children with ALL, and to explore its clinical significance in tracking changes of MRD in bone marrow. Methods: Modified limit dilution quantitative PLR method. Results: The average sensitivity was 4 copies. The quantitative MRD results of 14 newly diagnosed positive patients after induction of remission (CR) showed that the MRD quantitative value of bone marrow recurrence group was 0.343% on average and 0.004% on non-recurrence group (P <0.01) . Of the 14 cases, MRD was negative in 6 cases, persistent negative in 4 cases, positive in 2 cases (0.017%, 0.020% respectively), and MRD decreased gradually to negative after chemotherapy. Three cases of CR The average MRD was 0.077%. MRD decreased gradually in the remission period, of which 2 cases sustained clinical remission, 1 case had no recurrence of bone marrow but had testicular leukemia, 1 case had higher MRD and 2 sustained high values, 2 cases of MRD increased gradually, all 5 cases of recurrence. CONCLUSIONS: Patients with MRD positive at CR should be continuously monitored for their CR level. If they persist high or gradually increase, they are more likely to relapse and chemotherapy should be intensified to prevent relapse. The use of limit dilution quantitative detection of ALL MRD has the advantages of simple, high sensitivity.