CAJ | 학술논문

目的探讨CD38及ZETA相关蛋白(ZAP-70)在慢性淋巴细胞白血病(CLL)患者中的表达及其与临床分期的关系,分析其对预后的影响.方法采用流式细胞术检测42例CLL患者CD38及ZAP-70的表达水平,根据Rai分期将患者分为高危组(Ⅲ、Ⅳ期)(25例)和低中危组(0、Ⅰ、Ⅱ期)(17例),了解CD38和ZAP-70表达在Rai分期的分布情况,结合患者病情进展、化疗疗效进行分析.结果 CLL患者中CD38+者占47.6％(20/42),其中高危组64.0％(16/25),低中危组23.5％(4/17),两组差异有统计学意义(x2=6.645,P=0.014)；ZAP-70+者占40.5 ％(17/42),其中高危组60.0％( 15/25),低中危组11.8％(2/17),两组差异有统计学意义(x2=9.772,P=0.003)；ZAP-70+CD38+和ZAP-70+ CD38+患者多分布在高危组中,而ZAP-70-CD38+患者多分布在低中危组中,差异均有统计学意义(x2=10.076、9.346、6.005,均P＜0.05).随访48个月(1～ 136个月)后ZAP-70+CD38+及ZAP-70-CD38+患者无进展生存期分别为19.0和58.0个月,差异有统计学意义(x2=11.488,P=0.003),而ZAP-70+CD38+和ZAP-70- CD38+患者无进展生存时间分别为43.5和51.7个月,差异无统计学意义(x2=0.075,P=0.784).结论 CD38+和ZAP-70在CLL病程后期(Rai分期Ⅲ期和Ⅳ期)表达高于病程早期(Rai分期0期、Ⅰ期和Ⅱ期),CD38+和ZAP-70均阳性CLL患者较单阳性患者病情进展快,生存期明显缩短.
목적 탐토CD38급ZETA상관단백(ZAP-70)재만성림파세포백혈병(CLL)환자중적표체급기여림상분기적관계,분석기대예후적영향.방법 채용류식세포술검측42례CLL환자CD38급ZAP-70적표체수평,근거Rai분기장환자분위고위조(Ⅲ、Ⅳ기)(25례)화저중위조(0、Ⅰ、Ⅱ기)(17례),료해CD38화ZAP-70표체재Rai분기적분포정황,결합환자병정진전、화료료효진행분석.결과 CLL환자중CD38+자점47.6％(20/42),기중고위조64.0％(16/25),저중위조23.5％(4/17),량조차이유통계학의의(x2=6.645,P=0.014)；ZAP-70+자점40.5 ％(17/42),기중고위조60.0％( 15/25),저중위조11.8％(2/17),량조차이유통계학의의(x2=9.772,P=0.003)；ZAP-70+CD38+화ZAP-70+ CD38+환자다분포재고위조중,이ZAP-70-CD38+환자다분포재저중위조중,차이균유통계학의의(x2=10.076、9.346、6.005,균P＜0.05).수방48개월(1～ 136개월)후ZAP-70+CD38+급ZAP-70-CD38+환자무진전생존기분별위19.0화58.0개월,차이유통계학의의(x2=11.488,P=0.003),이ZAP-70+CD38+화ZAP-70- CD38+환자무진전생존시간분별위43.5화51.7개월,차이무통계학의의(x2=0.075,P=0.784).결론 CD38+화ZAP-70재CLL병정후기(Rai분기Ⅲ기화Ⅳ기)표체고우병정조기(Rai분기0기、Ⅰ기화Ⅱ기),CD38+화ZAP-70균양성CLL환자교단양성환자병정진전쾌,생존기명현축단.
Objective To investigate the expression of CD38 and ZAP-70 in chronic lymphocytic leukemia and the relationship between the clinical stages and prognostic significance.Methods Flow cytometry was used to analyze CD38 and ZAP-70 expression in CLL,the patients were divided into high-risk group (Ⅲ,Ⅳ stage) (25 cases) and low-medivm risk group (0,Ⅰ,Ⅱ stage) (17 cases) according to Rai clinical stages.The distribution of CD38 and ZAP-70 expression in Rai clinical stages and the prognostic significance were analyzed.Results Positive expression of CD38 was 47.6 ％ (20/42) in all patients,64.0 ％(16/25) patients in high-risk group and 23.5 ％ (4/17) in low-medium risk group.The distribution of CD38 expression had significant difference between two groups (x2 =6.645,P =0.014).Positive expression of ZAP-70 was 40.5 ％ (17/42) in all patients,60.0 ％ (15/25) patients in high-risk group and 11.8 ％ (2/17) in low-medium risk group.The distribution of ZAP-70 expression had significant difference between two groups (x 2 =9.772,P =0.003).The patients with ZAP-70+ CD38 and ZAP-70+ CD38 were more distribute in high risk campare to the CD38+ ZAP-70- in low-medium risk group (x 2=10.076,9.346,6.005,all P ＜ 0.05).Follow-up 48 months (1-136 months),the progression-free survival of patients with ZAP-70+ CD38+ and ZAP-70 CD38 were respectively for 19.0 and 58.0 months (x2 =11.488,P =0.003).The progression-free survival of ZAP-70+CD38 or ZAP-70 CD38+ were 43.5 and 51.7 months and not statistically significant (x2 =0.075, P =0.784).Conclusion CD38 and ZAP-70 positive expression occurs in large proportion of CLL patients with advanced stages (Rai Ⅲ and Ⅳ stage) and according to the clinical stages the expression of CD38 and ZAP-70 may be predicted.The current findings suggest that both ZAP-70 and CD38 expression should be assessed in patients with CLL for the definition of prognostic subgroups.