论文部分内容阅读
目的比较高、低剂量干扰素(IFN)α2b治疗慢性粒细胞性白血病(CML)的效果。方法建立检测融合基因bcr abl的荧光实时定量逆转录聚合酶链反应(RQ PCR)方法,观察治疗后融合基因表达水平的变化。选择30例临床初诊的CML患者随机分为两组,先服用羟基脲控制外周血白细胞达20×109/L以下,然后分别给予IFNα2b300万IU隔日皮下注射(3MIU组)和500万IU每周6次(5MIU组)皮下注射,治疗3～6个月,每月抽取骨髓标本,检测融合基因bcr abl的表达情况。结果RQ PCR的灵敏度达50拷贝bcr abl;分别取1×103拷贝/μl和1×107拷贝/μlbcr abl质粒,以及1例CML患者的cDNA同时作8管平行扩增bcr abl融合基因,批内变异系数分别为2.35%、1.48%和1.17%,不同批次之间以K562细胞cDNA作重复性分析,批间变异系数为5.13%;CML初诊患者bcr abl/GAPDH水平介于0.010～5.799,中位值为0.098;治疗3个月后3MIU组和5MIU组患者骨髓bcr abl水平平均下降19%和24%,两组比较差异无统计学意义(P=0.398),但是3MIU组副作用相对较小。结论RQ PCR监测融合基因bcr abl表达可以有效观察CML患者使用IFN的治疗效果;不同CML患者白血病细胞的bcr abl表达水平有较大差异;隔日3MIUIFN皮下注射治疗即可有效抑制CML白血病细胞的增殖,且副作用较小。
Objective To compare the effect of high and low dose interferon (IFN) α2b in the treatment of chronic myelogenous leukemia (CML). Methods Fluorescence real-time quantitative reverse transcription-polymerase chain reaction (RQ PCR) method was established to detect the fusion gene bcr abl and the change of fusion gene expression was observed. Thirty patients with newly diagnosed CML were randomly divided into two groups. The first administration of hydroxyurea controlled the peripheral blood leukocytes to below 20 × 109 / L, and then were given IFNα2b 3 million IU every other day subcutaneously (3MIU group) and 5 million IU weekly (5MIU group) subcutaneously for 3 to 6 months. Bone marrow samples were taken monthly to detect the expression of fusion gene bcr abl. Results The sensitivity of RQ PCR was 50 copies of bcr abl; 1 × 103 copies / μl and 1 × 107 copies / μl bcr abl plasmids respectively, and one cDNA of CML patients were used to amplify the bcr abl fusion gene in parallel. The coefficient of variation (CV) was 2.35%, 1.48% and 1.17% respectively. The variation coefficient of inter-assay was 5.13%. The levels of bcr abl / GAPDH in newly diagnosed CML ranged from 0.010 to 5.799 The median value of bcr abl in 3MIU group and 5MIU group decreased by 19% and 24% respectively after 3 months of treatment. There was no significant difference between the two groups (P = 0.398), but the side effects in 3MIU group were relatively small. Conclusion The expression of bcr abl gene in CML patients can be effectively observed by RQ PCR in monitoring the expression of bcr abl gene. The expression levels of bcr abl in leukemia cells of different CML patients are significantly different. Subcutaneous injection of 3MIUIFN on the next day can effectively inhibit the proliferation of CML leukemia cells, And less side effects.