摘要
目的 检测急性淋巴细胞白血病(acute lymphoblastic leukemia, ALL)儿童血清微小核糖核酸(microRNA,miR)-1301-3p,足糖萼蛋白(podocalyxin,PODXL)的表达情况,探讨二者表达水平对儿童急性淋巴细胞白血病的诊断和预后价值。方法 以2017年1月~2019年1月江油市第二人民医院收治的146例儿童急性淋巴细胞白血病患者为观察组,另选取同期体检的健康儿童100例作为对照组。采用实时荧光定量PCR(qRT-PCR)技术检测两组血清miR-1301-3p表达水平;采用酶联免疫吸附(ELISA)法检测两组血清PODXL表达水平。采用Pearson相关性分析血清miR-1301-3p和PODXL的关系;采用受试者工作特征(ROC)曲线评估患者血清miR-1301-3p和PODXL表达对儿童急性淋巴细胞白血病的诊断价值;采用Kaplan-Meier法分析血清miR-1301-3p和PODXL表达对预后的影响;采用COX回归分析影响儿童急性淋巴细胞白血病的危险因素。结果 观察组血清miR-1301-3p(0.81±0.13)表达水平低于对照组(0.98±0.11),血清PODXL(18.69±4.96 ng/ml)表达水平高于对照组(15.56±4.32 ng/ml),差异具有统计学意义(t=10.710,5.119,均P <0.001)。Pearson相关性分析显示,观察组血清miR-1301-3p和PODXL表达水平呈负相关(r=-0.487,P<0.05)。血清miR-1301-3p和PODXL联合诊断儿童急性淋巴细胞白血病的AUC(95%CI:0.893~0.967)大于miR-1301-3p单独诊断的AUC(95%CI:0.806~0.910)(Z=2.236,P=0.025)及PODXL单独诊断的AUC(95%CI:0.665~0.792)(Z=5.428,P<0.001)。血清miR-1301-3p表达水平与染色体核型、淋巴结肿大、MLL基因重排、危险分层、白细胞计数有关(χ^(2)=4.375,5.047,5.773,11.333,12.962,均P <0.05)。PODXL表达水平与白细胞计数、危险分层、染色体核型、MLL基因重排、淋巴结肿大有关(χ^(2)=7.038,7.912,11.440,11.843,23.708,均P <0.05)。生存分析显示,miR-1301-3p高表达组患者的总生存率高于miR-1301-3p低表达组(χ^(2)=10.311,P <0.05);PODXL低表达组的总生存率明显高于PODXL高表达组(χ^(2)=9.419,P <0.05)。多因素COX回归分析表明,miR-1301-3p低表达(95%CI:1.061~3.118)、PODXL高表达(95%CI:1.030~2.291)、白细胞计数≥50×10~9/L(95%CI:1.096~2.943)、中高危险分层(95%CI:1.418~4.614)和MLL基因重排阴性(95%CI:1.432~8.454)是影响儿童急性淋巴细胞白血病不良预后的危险因素(均P <0.05)。结论 儿童急性淋巴细胞白血病患者血清miR-1301-3p呈低表达而PODXL呈高表达,二者表达水平对疾病的诊断和预后均具有良好评估效果。
Objective To detect the expression of microRNA(miR)-1301-3p and podocalyxin(PODXL)in serum of children with acute lymphoblastic leukemia(ALL),and explore the diagnostic and prognostic value of the two expression levels in childhood acute lymphoblastic leukemia.Methods From January 2017 to January 2019,146 children with acute lymphoblastic leukemia patients who were treated in the Second People’s Hospital of Jiangyou were served as the observation group.Another 100 healthy children who underwent physical examination in the hospital during the same period were served as the control group.The expression level of miR-1301-3p in the serum of the two groups was detected by real-time fluorescence quantitative PCR(qRT-PCR)technology,and the expression level of PODXL in serum of the two groups was detected by enzyme-linked immunosorbent assay(ELISA).Pearson correlation was used to analyze the relationship between miR-1301-3p and PODXL expression in serum.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of serum miR-1301-3p and PODXL expression in children with acute lymphoblastic leukemia.Kaplan-Meier method was used to analyze the effect of serum miR-1301-3p and PODXL expression on the prognosis of patients,and COX regression analysis was used to analyze the risk factors affecting acute lymphoblastic leukemia in children.Results The expression level of serum miR-1301-3p(0.81±0.13)in the observation group was lower than that in the control group(0.98±0.11),the expression level of serum PODXL(18.69±4.96 ng/ml)was higher than that in the control group(15.56±4.32 ng/ml),and the differences were statistically significant(t=10.710,5.119,all P<0.001).Pearson correlation analysis showed that the expression levels of miR-1301-3p and PODXL in serum of the observation group were negatively correlated(r=-0.487,P<0.05).The AUC(95%CI:0.893~0.967)of serum miR-1301-3p combined PODXL expression in the diagnosis of childhood acute lymphoblastic leukemia was greater than that of miR-1301-3p alone(95%CI:0.806~0.910)(Z=2.236,P=0.025)and PODXL alone(95%CI:0.665~0.792)(Z=5.428,P<0.001).The expression levels of serum miR-1301-3p were associated with karyotype,lymphadenopathy,MLL gene rearrangement,risk stratification and white blood cell count(χ^(2)=4.375,5.047,5.773,11.333,12.962,all P<0.05).The expression levels of serum PODXL were associated with white blood cell count,risk stratification,karyotype,MLL gene rearrangement and lymphadenopathy(χ^(2)=7.038,7.912,11.440,11.843,23.708,all P<0.05).Survival analysis showed that the overall survival rate of patients in the miR-1301-3p high expression group was higher than that in the miR-1301-3p low expression group(χ^(2)=10.311,P<0.05),the overall survival rate in PODXL low expression group was obviously higher than that in the PODXL high expression group(χ^(2)=9.419,P<0.05).Multivariate COX regression analysis showed that low expression of miR-1301-3p(95%CI:1.061~3.118),high expression of PODXL(95%CI:1.030~2.291),white blood cell count≥50×10^(9)/L(95%CI:1.096~2.943),medium-high risk stratification(95%CI:1.418~4.614),and negative MLL gene rearrangement(95%CI:1.432~8.454)were risk factors for poor prognosis in children with acute lymphoblastic leukemia(all P<0.05).Conclusion The serum miR-1301-3p expression in children with acute lymphoblastic leukemia was low and PODXL is high expression,and the expression levels of both have good evaluation effects on the diagnosis and prognosis of the disease.
作者
岳俊刚
陈芳
YUE Jungang;CHEN Fang(Department of Clinical Laboratory,the Second People’s Hospital of Jiangyou,Sichuan Jiangyou 621701,China)
出处
《现代检验医学杂志》
CAS
2023年第6期64-70,共7页
Journal of Modern Laboratory Medicine
基金
2020年度江油市科技计划项目(27):江油地区0~6岁健康儿童外周血淋巴细胞亚群调查分析。
