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目的 :为了研究白血病个体残留白血病细胞的数量变化情况及与白血病临床复发和化疗效应的相互关系。方法 :应用竞争性PCR技术 ,定量检测急性淋巴细胞白血病细胞中克隆性重排的T细胞受体γ(TCRγ)基因。结果 :检测 5 4例ALL患者的 1 5 8份骨髓标本 ,随访时间中位数为 33.5月。在临床缓解时 36例患者的白血病细胞 <0 .0 0 0 1 % ,1 8例定量为0 .35 4%± 0 .32 7%。残留白血病细胞数在缓解后第一年显著下降 ,之后下降不显著。部分患儿在白血病复发前可检测到其残留白血病细胞明显地增高 ,而部分患者缓解后残留白血病细胞数量持续存在但临床无复发。在白血病的诱导缓解期 ,对白血病细胞的杀伤效应与缓解早期的残留白血病细胞数量显著相关 (0 .1 2 1 %± 0 .0 34%vs0 .2 5 8%± 0 .1 30 % ,P <0 .0 0 1 ) ,并与临床复发率相关。结论 :大剂量化疗显著地降低白血病细胞负荷 ,但难以彻底清除残留白血病细胞 ,残留白血病细胞的检测有助于预测临床复发。白血病个体间化疗效应差异显著 ,应用定量检测残留白血病细胞的方法对化疗效应进行定量评价 ,有助于制定个体化的治疗方案
OBJECTIVE: To investigate the changes of the number of residual leukemia cells in leukemia individuals and their correlation with the clinical relapse and chemotherapeutic effects of leukemia. Methods: Clonal rearranged T cell receptor γ (TCRγ) gene was detected by competitive PCR in acute lymphoblastic leukemia cells. Results: A total of 158 bone marrow samples from 54 ALL patients were tested. The median follow-up time was 33.5 months. Thirty-six leukemia cells in clinical remission were <0.0001% and 18 were quantified as 0.354% ± 0.327%. Residual leukemia cells in the first year after remission decreased significantly, after the decline was not significant. Some children before leukemia relapse detection of residual leukemia cells was significantly increased, while some patients with residual leukemia cells persist but the number of relapsed without clinical. In the induction of leukemia, the killing effect on leukemia cells was significantly correlated with the number of residual leukemia cells in the early stage of leukemia (0.121% ± 0.344% vs0.258% ± 0.130%, P <0 0 01), and with the clinical relapse rate. Conclusion: High-dose chemotherapy can significantly reduce the leukemia cell load, but it is difficult to completely remove residual leukemia cells. Detection of residual leukemia cells can help predict the clinical relapse. Chemotherapy effect of leukemia individuals significantly different, the application of quantitative detection of residual leukemia cells in the quantitative evaluation of the effect of chemotherapy, contribute to the development of individualized treatment programs