目的探讨高白细胞急性髓系白血病(hyperleukocytic acute myeloid leukemia,HAML)患者治疗前后血清可溶性细胞间粘附分子-1(sICAM-1)、可溶性血管细胞粘附分子(sVCAM-1)和可溶性CD44分子(sCD44)的表达水平及其临床意义。方法采用酶联免疫吸附实验(ELISA),对15例初诊高白细胞急性髓系白血病(WBC>100×109/L)和40例非高白细胞急性髓系白血病(non-hyperleukocytic acute myeloid leukemia,NHAML)(WBC<100×109/L)患者治疗前后的血清sICAM-1、sVCAM-1和sCD44水平进行检测并与正常人比较。结果①HAML组及NHAML组患者化疗前血清的sICAM-1、sVCAM-1和sCD44水平均显著高于对照组,差异有统计学意义,化疗后,两组中骨髓达到缓解者sICAM-1、sVCAM-1和sCD44水平下降,与治疗前比较差异有统计学意义,与对照组比较,差异无统计学意义；②化疗前,HAML组患者血清的sICAM-1、sVCAM-1和sCD44水平显著高于NHAML组患者血清的水平(<0.05),HAML组缓解率40%低于NHAML组缓解率72.5%(<0.05)。结论对于HAML患者,检测血清sICAM-1、sVCAM-1和sCD44水平,有助于指导临床治疗,为病情监测、疗效观察及预后判定提供了有价值的临床指标。%Objective Discussion on hyperleukocytic acute myeloid leukemia (HAML) before and after treatment in patients with serum soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular celladhesion molecule-1(sVCAM-1) and soluble CD44 molecule (sCD44) expression level and its clinical significance. Methods By using enzyme linked immunosorbent assay (ELISA), were detected in 15 patients with HAML (WBC>100í109/L) and 40 patients with non-hyperleukocytic acute myeloid leukemia (NHAML, WBC<100í109/L) before and after treatment the serum sICAM-1, sVCAM-1 and sCD44 levels, and compared with the normal people. Results ①Before chemotherapy, NAML and NHAML patient serum sICAM-1, sVCAM-1 and sCD44 levels were significantly higher than those in the control group, the difference has statistical significance. After chemotherapy, in the two groups to achieve remission of bone marrow sICAM-1, sVCAM-1 and sCD44 levels decreased, compared with before treatment was statistical y significant; Compared with the control group, no significant difference. ②Before chemotherapy, HAML patients serum sICAM-1, sVCAM-1 and sCD44 levels were significantly higher than those in NHAML patients with serum sICAM-1, sVCAM-1 and sCD44 level ( <0. 05), HAML patients remission rate (40%) was lower than NHAML patients remission rate (72.5%)( <0.05). Conclusion For patients with HAML, detection of serum sICAM-1, sVCAM-1 and sCD44 levels, help to guide the clinical treatment, provides valuable clinical indicators for monitoring, curative effect observation and prognosis.
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