急性白血病多药耐药蛋白异常表达及其及临床疗效及预后关系.doc

急性白血病多药耐药蛋白异常表达及其及临床疗效及预后关系 　 作者：张群岭，张梅，贺鹏程，蔡瑞波，刘亚琳，郭桂丽，关虹 【摘要】 目的 研究多药耐药蛋白P糖蛋白(PGP)、多药耐药相关蛋白1(MRP1)、谷胱甘肽硫转移酶π(GSTπ)和拓扑异构酶Ⅱα(TOPOⅡα)在初发急性白血病(AL)患者中的表达，并探讨其与疗效及预后之间的关系。方法 采用免疫组化SABC法检测了PGP、MRP1、GSTπ、TOPOⅡα在30例AL患者白血病细胞中的表达情况。结果 PGP、MRP1、GSTπ、TOPOⅡα在初发AL中表达的阳性率分别为23.33%、36.6%、60%和43.33%；PGP 、MRP1阳性组的完全缓解(CR)率均明显低于阴性组(Plt;0.01)；TOPOⅡα阳性组的CR率为92.31%，高于阴性组的58.82%(Plt;0.05)；GSTπ阳性组的CR率与阴性组的CR率之间无统计学意义(Pgt;0.05)。结论 单一PGP、MRP1的表达升高及TOPOⅡα的表达降低与AL的治疗反应差、预后不良有明显的相关性；联合多个多药耐药蛋白能够更准确地预测AL的耐药和预后。 【关键词】 急性白血病；多药耐药；疗效；预后 　　Relationship between ectopic expression of multidrug　resistancerelated proteins and clinical efficacy　and prognosis in acute leukemia 　　ABSTRACT: Objective To study the expression of multidrug resistancerelated protein PGP, MRP1, GSTπ and TOPOⅡα in de novo acute leukemia(AL) and explore the relationship between its expression and chemotherapy efficacy and prognosis. Methods The expression of PGP, MRP1, GSTπ and TOPOⅡα was detected by SABC method of immunohistochemistry in leukemia cells of 30 de novo patients. Results The positive rate of PGP, MRP1, GSTπ and TOPOⅡα was 23.33%, 36.6%, 60% and 43.33% in de novo AL, respectively. The complete remission (CR) rate in PGP or MRP1 positive group was obviously lower than that in PGP or MRP1 negative group(Plt;0.01). The CR rate of TOPOⅡα positive group (92.31% ) is higher than TOPOⅡα negative group (58.82%, Plt;0.05). There was no significant difference between GSTπ positive group and GSTπ negative group (Pgt;0.05). Conclusion Single overexpression of PGP and MRP1 or single decreased expression of TOPOⅡα is strongly related to poor chemotherapy efficacy and poor prognosis in AL. Combining more than one multidrug resistancerelated proteins can predict the drug resistance and chemotherapy efficacy more accurately in AL. 　　KEY WORDS: acute Leukemia (AL); multidrug resistance (MDR); chemotherapy efficacy; prognosis 　　多药耐药(multidrug resistance, MDR)是导致白血病化疗失败的最主要的原因之一，也是彻底治愈白血病的最大障碍。近年来研究发现，白血病细胞膜转运蛋白P糖蛋白(P