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目的 :观察 Ph染色体、bcr/ abl融合基因与慢性粒细胞白血病 (CML)诊断、疗效、预后的关系。方法 :用姬姆萨 G带显带法和反转录筑巢式聚合酶链反应 (RT- nest- PCR)对 41例初、复治 CML 患者的骨髓标本进行了分析。将 Ph染色体及 bcr/ abl融合基因均为阳性的慢性期患者随机分成二组 ,分别以干扰素 - α(IFN- α)、羟基脲 (HU)及乌苯美司 (Bestatin、BS)、HU治疗 ,6月后复查核型及 bcr/ abl融合基因。结果 :41例病例中 36例 Ph染色体及 bcr/ abl融合基因均为阳性 ,Ph—、bcr/ abl+ 5例 ,其中 b3a2 转录本 2 9例 ,b2 a2 转录本 12例 ;在可评价的 2 0例病例中 ,两个治疗组各 10例 ,IFN- α治疗组全部达 CHR,2例获得部分细胞遗传学反应 (PGR) ,5例获微小细胞遗传学反应 (Mi GR) ;3例无细胞遗传学反应 ;BS治疗组全部达 CHR,6例达 Mi GR;全部病例均未获分子生物学反应 ;二组治疗均使 CML 获 Ph染色体量的下降 (P<0 .0 1) ,二组病例下降程度无差异 (P>0 .0 5 )。结论 :Ph染色体及 bcr/ abl融合基因均为 CML 重要的诊断指标 ,二者相结合意义更大 ;Ph染色体的量及其变化可判断疗效及预后 ;干扰素及乌苯美司治疗组均取得较好疗效 ,均能使患者获细胞遗传学反应 ,其细胞遗传学疗效无明显差别。
Objective : To observe the relationship between Ph chromosome and bcr/abl fusion gene and the diagnosis, curative effect and prognosis of chronic myelogenous leukemia (CML). METHODS: The bone marrow samples of 41 patients with primary and relapsed CML were analyzed by Giemsa G banding and RT-nested polymerase chain reaction (RT- nest-PCR). The chronic phase patients with positive Ph chromosome and bcr/abl fusion gene were randomly divided into two groups: interferon-alpha (IFN-alpha), hydroxyurea (HU), and urethane (Bestatin, BS), HU After treatment, karyotype and bcr/abl fusion genes were reviewed after 6 months. RESULTS: Of the 41 cases, 36 cases of Ph chromosome and bcr/abl fusion gene were positive, Ph-, bcr/abl+ were 5 cases, including 29 cases of b3a2 transcript and 12 cases of b2 a2 transcript; In the cases, 10 in each of the two treatment groups, all CHR in the IFN-α treatment group, partial cytogenetic response (PGR) in 2 patients, micro cytogenetic response (Mi GR) in 5 patients, and no cells in 3 patients. Genetic response: All patients in the BS group achieved CHR, and 6 cases reached Mi GR; all patients did not receive molecular biological responses; both groups resulted in a decrease in Ph chromosome counts in CML (P < 0.01). There was no difference in the degree of case reduction (P > 0.05). Conclusion: Ph chromosome and bcr/abl fusion gene are both important diagnostic indicators of CML, and the combination of the two is more significant; the amount and changes of Ph chromosome can be used to judge the efficacy and prognosis; both the interferon and Ubenomes treatment groups were obtained. The better curative effect can make the patient get cytogenetic response. There is no significant difference in cytogenetic efficacy.