CAJ | 학술논문

目的研究慢性粒细胞白血病(CML)患者血清α1-酸性糖蛋白(AGP)的水平与CML病情发展、伊马替尼血浆谷浓度和疗效的关系.方法 2008年8月至2010年2月南方医科大学南方医院血液科112例CML患者,其中男72例,女40例,中位年龄39(6~76)岁;慢性期102例,加速期4例,急性变期6例.有99例给予伊马替尼治疗,13例给予羟基脲治疗,20例健康献血者作为对照组,采用免疫比浊法检测AGP.有12例患者分别在伊马替尼治疗前和治疗后3个月同时检测AGP和伊马替尼浓度.84例应用伊马替尼治疗的患者同时采用高效液相色谱-质谱联用法检测伊马替尼血浆谷浓度.按疗效分组评价AGP水平的意义及其与伊马替尼浓度的关系.结果未缓解(NR)组血清AGP水平[(1.18±0.26)g/L]显著高于完全细胞遗传学缓解(CCR)组、完全血液学缓解(CHR)组及对照组[(0.60±0.21)、( 0.71±0.17)、(0.52±0.15) g/L,均P<0.05];加速急变期组[ (1.28±0.50) g/L]高于CCR组及对照组(均P<0.05);CHR组高于对照组(P<0.05).而CCR组与CHR组及对照组间差异均无统计学意义 (均P>0.05).NR组与复发组及加速急变期组差异均无统计学意义(均P>0.05).12例患者在伊马替尼治疗后第3个月时AGP水平低于治疗前[(0.54±0.17)g/L 比(0.83±0.31)g/L,P<0.01].84例CML患者的伊马替尼血浆谷浓度为(1307±586)μg/L(109~3400 μg/L),与AGP水平正相关(r=0.443,P<0.01).结论 CML患者血清AGP水平能够反映体内白血病细胞负荷,与伊马替尼血浆谷浓度呈正相关,可作为CML患者疗效监测指标之一.
목적 연구만성립세포백혈병(CML)환자혈청α1-산성당단백(AGP)적수평여CML병정발전、이마체니혈장곡농도화료효적관계.방법 2008년8월지2010년2월남방의과대학남방의원혈액과112례CML환자,기중남72례,녀40례,중위년령39(6~76)세;만성기102례,가속기4례,급성변기6례.유99례급여이마체니치료,13례급여간기뇨치료,20례건강헌혈자작위대조조,채용면역비탁법검측AGP.유12례환자분별재이마체니치료전화치료후3개월동시검측AGP화이마체니농도.84례응용이마체니치료적환자동시채용고효액상색보-질보련용법검측이마체니혈장곡농도.안료효분조평개AGP수평적의의급기여이마체니농도적관계.결과 미완해(NR)조혈청AGP수평[(1.18±0.26)g/L]현저고우완전세포유전학완해(CCR)조、완전혈액학완해(CHR)조급대조조[(0.60±0.21)、( 0.71±0.17)、(0.52±0.15) g/L,균P<0.05];가속급변기조[ (1.28±0.50) g/L]고우CCR조급대조조(균P<0.05);CHR조고우대조조(P<0.05).이CCR조여CHR조급대조조간차이균무통계학의의 (균P>0.05).NR조여복발조급가속급변기조차이균무통계학의의(균P>0.05).12례환자재이마체니치료후제3개월시AGP수평저우치료전[(0.54±0.17)g/L 비(0.83±0.31)g/L,P<0.01].84례CML환자적이마체니혈장곡농도위(1307±586)μg/L(109~3400 μg/L),여AGP수평정상관(r=0.443,P<0.01).결론 CML환자혈청AGP수평능구반영체내백혈병세포부하,여이마체니혈장곡농도정정상관,가작위CML환자료효감측지표지일.
Objective To explore the relationship between serum α1-acid glycoprotein (AGP), disease progression, imatinib plasma trough concentration and efficacy in the patients with chronic myeloid leukemia (CML).Methods A total of 112 CML patients were recruited from August 2008 to February 2010 in our hospital. There were 72 males and 40 females with a median age of 39 years old (range: 6-76 years old). Among them, 102 patients were in chronic phase, 4 in accelerated phase and 6 in blastic phase. Ninety-nine patients were treated with imatinib while 13 patients received hydroxyurea. Twenty healthy blood donors were designated as the control group. The serum AGP levels of all patients were detected by immuno-turbidimetric assay. And the concentrations of AGP and imatinib were detected in 12 patients before and after 3 months of imatinib therapy respectively.For 84 CML patients, their plasma trough concentrations of imatinib were detected by high performance liquid chromatography-tandem mass spectrometry simultaneously.All patients were divided into 5 groups by efficacy to evaluate the significance of serum AGP and its relationship with imatinib concentration.Results Serum AGP of no response (NR) group [(1.18±0.26)g/L] was significant higher than that of complete cytogenetic response (CCR), complete hematologic response (CHR) and control group[ (0.60±0.21), ( 0.71±0.17),(0.52±0.15) g/L,all P<0.05]. Serum AGP of accelerated/blastic phase group [ (1.28±0.50) g/L]was significant higher than CCR or control group (P<0.05). Serum AGP of CHR group was higher than that of control group (P<0.05). No significant difference existed between CCR, CHR or control group (P>0.05). There were no significant differences between NR, relapse or accelerated/blastic phase group (P>0.05). The serum AGP of 12 patients on a 3-month therapy of imatinib were lower than that of patients at pre-treatment [(0.54±0.17)g/L vs(0.83±0.31)g/L,P<0.01]. The plasma trough concentration of imatinib was (1307± 586) μg/L (range: 109-3400 μg/L) in 84 patients. And it was positively correlated with the serum level of AGP (r=0.443, P<0.01).Conclusion The serum level of AGP can reflect the in vivo loads of leukemic cells for CML patients. There is a positive correlation between the serum level of AGP and the plasma trough concentration of imatinib. Serum AGP can be used as a monitoring index of efficacy for CML patients.