标题：FLT3-ITD急性髓系白血病的临床诊疗及生存状况研究

      作者：于洁 1，王侃 1，滕志 2    1.陕西核工业417医院内一科，陕西 西安 710600；2.陕西核工业215医院血液科，陕西 咸阳 712000

      卷次： 2019年30卷24期

      【摘要】 目的 研究FMS样酪氨酸激酶3 (FLT3)基因内部串联重复(ITD)的急性髓系白血病(AML)患者的临床诊疗及生存状况。方法 选取陕西核工业417医院2016年7月至2017年7月收治的98例确诊为AML的患者作为研究对象。根据聚合酶链反应(PCR)联合DNA法检测 FLT3-ITD基因突变情况分为两组，其中观察组为存在FLT3-ITD基因突变阳性(FLT3-ITD+)患者23例(阳性率为23.47%)，对照组FLT3-ITD突变阴性(FLT3-ITD-)患者75例(76.53%)。显微镜下观察并比较两组患者骨髓细胞形态及幼稚细胞数目，同时采用流式细胞数检测并分析患者的细胞学抗原表达情况及阳性细胞数；对患者细胞遗传学表现情况以及其他临床指标情况进行记录并对比分析。所有患者均接受化疗治疗，在化疗后3~4周时比较患者完全缓解(CR)、部分缓解(PR)及未缓解(NR)情况；随访1年，统计两组患者的总生存期(OS)及无事件生存期(EFS)。结果 观察组与对照组的性别、年龄比较差异均无统计学意义(P>0.05)；观察组患者的白细胞计数及骨髓原始细胞明显高于对照组，差异均具有统计学意义(P<0.05)；观察组患者的血红蛋白及血小板计数明显高于对照组，CD33、CD7的抗原阳性率明显高于对照组，CD16、CD15、CD34、CD117抗原阳性率明显低于对照组，差异均有统计学意义 (P<0.05)；观察组和对照组正常核型分别为 14例(60.87%)、46例(61.33%)，其中观察组预后良好率低于对照组，差异具有统计学意义(P<0.05)；观察组患者治疗 1个疗程后 CR为 39.13%，明显低于对照组的 73.33%，差异具有统计学意义(P<0.05)；经随访 1年，观察组患者的EFS为34.7%，明显低于对照组的65.3%，OS为43.4%，明显低于对照组的73.3%，差异均具有统计学意义(P<0.05)。结论 FLT3-ITD基因突变在AML患者中较为常见，FLT3-ITD突变阳性患者的白细胞水平升高，其完全缓解率及总体生存率均低于阴性患者，可用于评估AML患者预后情况。
      【关键词】 FMS样酪氨酸激酶3基因内部串联重复序列；急性髓系白血病；基因突变；预后评估；临床疗效
      【中图分类号】 R733.71 【文献标识码】 A 【文章编号】 1003—6350（2019）24—3173—05

Clinical diagnosis and survival status of FLT3-ITD positive or negative acute myeloid leukemia.
YU Jie 1, WANGKan 1, TENG Zhi 2. 1.Department of Internal Medicine, 417 Hospital of Shaanxi Nuclear Industry, Xi'an 710600, Shaanxi,CHINA; 2. Department of Hematology, 215 Hospital of Shaanxi Nuclear Industry, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To study the clinical diagnosis and survival of the acute myeloid leukemia (AML) pa-tients with internal tandem duplication (ITD) mutations in the Fms-like tyrosine-3 (FLT3) gene. Methods A total of 98patients diagnosed with AML, who admitted to 417 Hospital of Shaanxi Nuclear Industry from July 2016 to July 2017,were selected as subjects. The patients were divided into the two groups according to the mutations of FLT3-ITD genedetected by polymerase chain reaction (PCR) combined with DNA method: 23 cases patients (23.47% ) with positiveFLT3-ITD mutation (FLT3-ITD+, observation group) and 75 cases (76.53%) patients with negative FLT3-ITD mutation(FLT3-ITD-, control group). The morphology of bone marrow cells and the number of immature cells in the two groupswere observed and compared under microscope. The cytological antigen expression and the number of positive cellswere analyzed by flow cytometry. The cytogenetic performance of patients and other clinical indicators were recordedand compared. Complete remission (CR), partial remission (PR), and non-remission (NR) of the patients at 3 weeks to 4weeks after chemotherapy were compared. The total survival time (OS) and event-free survival time (EFS) of the pa-tients were calculated after one year of follow-up. Results There was no significant difference in gender and age be-tween the observation group and the control group (P>0.05); the white blood cell count and bone marrow blast cells ofthe observation group were significantly higher than those in the control group (P<0.05); the hemoglobin and plateletcounts of the observation group were significantly higher than those of the control group (P<0.05); the antigen positiverate of CD33 and CD7 was significantly higher than that of the control group (P<0.05); the positive rates of CD16,CD15, CD34 and CD117 antigens were significantly lower than those of the control group (P<0.05). The normal karyo-types of the observation group was 14 cases (60.87%) versus 46 cases (61.33%) of the control group; the prognosis ofthe observation group was significantly lower than that of the control group (all P<0.05). The CR in the observation