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目的:总结急性淋巴细胞白血病(急淋)患儿脑脊液中微小残留病(minimalresidualdis-ease,MRD)的变化及其临床意义。方法:确诊为急淋患儿18例,采用一步煮沸法提取脑脊液白细胞DNA,采用常规酚-氯仿抽提法提取骨髓DNA。追踪并采用改良的极限稀释法定量检测MRD值。分析初治病例在骨髓诱导达到缓解时脑脊液MRD值与预后的关系。结果:诱导缓解的18例中,9例脑脊液MRD阳性,9例阴性。经随访MRD阳性者,有5例发生中枢神经系统白血病(centralnervoussystemleukemia,CNSL);而阴性者无1例发生CNSL。结论:急淋完全缓解时,脑脊液MRD高水平者发生CNSL的危险性较高,故追踪检测脑脊液MRD对临床CNSL的预防、治疗有一定的指导意义。
Objective: To summarize the changes of cerebrospinal fluid minimal residual disease (MRD) in children with acute lymphoblastic leukemia and its clinical significance. Methods: 18 cases of acute lymphocytic leukemia were diagnosed. One step boiling method was used to extract cerebrospinal fluid leukocyte DNA. The bone marrow DNA was extracted by conventional phenol - chloroform extraction. MRD values were tracked and quantified using a modified limiting dilution method. To analyze the relationship between MRD and prognosis of newly diagnosed cases when bone marrow induction is remission. Results: Among the 18 cases that induced remission, 9 cases had cerebrospinal fluid MRD positive and 9 cases negative. After follow-up of MRD positive, 5 cases of central nervous system leukemia (central nervous system leukemia, CNSL); and negative in no case of CNSL. CONCLUSION: When acute lymphrhea is completely relieved, there is a high risk of developing CNSL in cerebrospinal fluid with high MRD level. Therefore, tracing and detecting cerebrospinal fluid MRD has some guiding significance for the prevention and treatment of clinical CNSL.