急性白血病多药耐药蛋白的异常表达及其与临床疗效和预后的关系

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(P<0.01);TOPOⅡα阳性组的CR率为92.31%,高于阴性组的58.82%(P<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(P>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。

Relationship between ectopic expression of multidrug resistance-related proteins and clinical efficacy and prognosis in acute leukemia

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(P<0.01).The CR rate of TOPOⅡα positive group(92.31%) is higher than TOPOⅡα negative group(58.82%,P<0.05).There was no significant difference between GST-π positive group and GST-π negative group(P>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.