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Daxx和E2F1在儿童急性白血病中的表达及其临床意义
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摘要
目的:Daxx(death domain associate protein死亡结构域相关蛋白)是一种多功能核蛋白,在细胞凋亡、转录调控、病毒感染等方面发挥重要作用。E2F1( E2 promoter binding factor-1,E2启动子结合因子-1)转录因子,是E2F家族的重要成员,在调节细胞周期进程和调节细胞增殖过程中起关键作用,其过度表达能刺激细胞增殖。本实验通过应用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结(streptavidinperosi-dase, SP)方法检测急性白血病患儿骨髓细胞中Daxx和E2F1的表达情况,探讨二者在白血病发病中的作用,为儿童白血病的发生发展机制提供新的思路,为其早期诊断提供理论依据,也为白血病的早期防治提供新靶点。
     方法:
     1病例及分组:本研究将2008年6月-2009年6月于我院确诊的初诊未治急性白血病患儿40例作为观察组;包括急性淋巴细胞白血病(acute lymphoblastic leukemia, ALL)组23例、急性髓细胞性白血病(acute myelocytic leukemia, AML)组17例。ALL组包括L1 3例、L2 20例、无L3病例,其中高危7例,标危16例;AML组包括M2 4例、M3 4例、M4 4例、M53例、M6 1例、M7 1例、无M1病例。另将性别和年龄与观察组相匹配的20例非恶性血液病患儿作为对照组。
     2标本采集及处理:分别抽取观察组和对照组每个患儿骨髓液0.2ml,涂片后4℃丙酮固定30分钟,-20℃保存备用,之后应用免疫组化SP法检测Daxx和E2F1的表达。
     3统计学分析:应用SPSS13.0统计学软件对所得数据进行卡方检验(或Fisher确切概率法)及相关分析;以P<0.05为差异具有显著性意义
     结果:
     1 Daxx的表达情况
     1.1 Daxx蛋白在观察组患儿中的阳性表达率(40%)明显高于对照组(10%),两者间的差异具有显著性(χ2=5.71,P<0.05)。
     1.2 Daxx蛋白在AML组患儿中的阳性表达率(58.8%)高于ALL组(26.1%),两者间的差异具有显著性(χ2=4.365,P<0.05)。
     1.3 Daxx在ALL- L1组患儿中的阳性表达率(33.3%)与ALL- L2组(25%)相比,两者间的差异无显著性(P=1, P>0.05)。
     1.4 Daxx在ALL高危组的阳性表达率(57.1%)明显高于标危组(12.5%),两者间的差异具有显著性(P=0.045,P<0.05)。Daxx在ALL高危组的阳性表达率与对照组(10%)相比,两者间的差异具有显著性(P=0.024,P<0.05);Daxx在ALL标危组的阳性表达率与对照组相比,两者间的差异无显著性(P=1.0,P>0.05)。
     1.5 Daxx在17例AML组各亚型组中的阳性例数依次为3例、3例、2例、2例、0例、0例。阳性率依次为75%、75%、50%、66.67%、0%、0%。因M6、M7各仅有1例且无阳性表达,故将M2、M3、M4、M5各组间进行卡方检验。各组表达水平间差异无显著性(P>0.05)。
     1.6 Daxx阳性组的缓解率(56.3%)低于阴性组(91.7%),两者间差异具有显著性意义(P<0.05)。
     2 E2F1的表达情况
     2.1 E2F1在观察组患儿中的阳性表达率(57.5%)明显高于对照组(20%),两者间的差异具有显著性(χ2=7.576,P<0.05)。
     2.2 E2F1在AML组患儿中的阳性表达率(64.7%)与ALL组(52.2%)相比,两者间的差异无显著性(χ2=0.628,P>0.05)。
     2.3 E2F1在ALL-L1组患儿中的阳性表达率(33.3%)与ALL-L2组(55%)相比,两者间的差异无显著性(P=0.59, P>0.05)。
     2.4 E2F1在ALL高危组的阳性表达率(71.4%)与标危组(56.3%)相比,两者间的差异无显著性(P=0.657,P>0.05)。E2F1在ALL高危组的阳性表达率与对照组(20%)相比,两者间的差异具有显著性(P=0.023,P<0.05)。E2F1在ALL标危组的阳性表达率与对照组相比,两者间的差异具有显著性(χ2=5.063,P<0.05)。
     2.5 E2F1在17例AML组在各亚型组中的阳性例数依次为3例、3例、3例、2例、0例、0例。阳性率依次为75%、75%、75%、66.67%、0%、0%。因M6、M7各仅有1例且无阳性表达,故将M2、M3、M4、M5各组间进行卡方检验。各组表达水平间差异无显著性(P>0.05)。
     2.6 E2F1阳性组的缓解率(69.6%)低于阴性组(88.2%),两者间差异无显著性(P>0.05)。
     3.在观察组患儿中,Daxx与E2F1的表达水平进行相关分析:χ2=14.339,P<0.05,说明二者呈正相关关系。
     结论:
     1 Daxx和E2F1在儿童急性白血病初诊时为高水平表达,提示它们可以作为急性白血病的一种检测指标。
     2 Daxx在AML中的表达水平高于ALL,说明它的表达与AL的分型具有一定相关性。Daxx阴性组在AL中的缓解率高于阳性组,说明Daxx可能成为提示儿童AL临床预后的指标之一。
     3实验表明Daxx与E2F1在儿童急性白血病中表达正相关,提示二者在儿童急性白血病的发生发展过程中可能存在某种协同作用。
Objective: Daxx (death domain associate protein), a kind of multifunction nucleoprotein, plays an important part in cell apoptosis, transcriptional control, viral infection and so on. E2F1 (E2 promoter binding factor-1), transcription factor, an important member of E2F family,plays a key point in the proceeding of cell cycle regulation and the process of cell multiplication, and cell multiplication could be stimulated by the over expression of E2F1. In this study we used the method of immunohistochemical streptavidin-perosidase (IHC, SP) to detect the expression of Daxx and E2F1 in bone marrow cell (BMC) of childhood acute leukemia (AL), and research their effect in the process of leukemia. It may provide a new way for childhood acute leukemia’s mechanisms, a theoretical basis for the early diagnosis of AL and new targets for the prevention and treatment of early leukemia.
     Methods:
     1 Patients and groups: 40 children who were newly diagnosed with acute leukemia were collected in our hospital from June, 2008 to June, 2009, as experiment group. There were 23 patients with acute lymphoblastic leukemia (ALL), which includes 3 cases of L1 and 20 cases of L2 (with no L3 case); and 7 cases of high risk, 16 cases of standard risk. There were 17 patients with acute myeloblastic leukemia (AML) which includes 4 cases of M2 ,4 cases of M3 , 4 cases of M4 ,3 cases of M5 , 1 case of M6 and 1 case of M7 (no M1 case). The control group included 20 cases of non-malignant hematological disease children whose sex and age matched with experiment group.
     2 Samples collection and operating sequence: 0.2ml bone marrow were collected from all of the 40 patients with acute leukemia and 20 cases of non-malignant hematological disease children, after film preparation, they were all fixed by acetone of 4℃for 30 minutes, then preserve them in -20℃ for reserve. Daxx and E2F1 were all measured by SP.
     3 Statistic analysis: SPSS 13.0 was used to analysis the data. Analysis methods included chi square test (or Fisher exact propability) and correlation analysis.A P value of less than 0.05 was considered as significant.
     Results:
     1 The expression of Daxx in bone marrow cell
     1.1 The positive rate of Daxx protein in 40 acute leukemia patients(40%) was significantly higher than the rate of 20 control cases(10%) (χ2=5.71, P<0.05).
     1.2 The positive rate of Daxx protein in 17 AML patients(58.8%) was significantly higher than the rate of ALL cases(26.1%) (χ2=4.365, P<0.05).
     1.3 The positive rate of Daxx protein in ALL-L1(33.3%) and in ALL-L2 patients(25%) were basically the same, there was no significant difference between them(P=1,P>0.05).
     1.4 The positive rate of Daxx protein in ALL who were high risk(ALL-HR) patients(57.1%) was significantly higher than those standard risk (ALL-SR)cases(12.5%) (P=0.045,P<0.05). The positive rate of Daxx protein in ALL-HR group was significantly higer than the rate of control group(10%) (P=0.024,P<0.05); and the difference between the rate of ALL-SR and control group was no significance (P=1,P>0.05).
     1.5 There were 17 patients with acute myeloblastic leukemia (AML). In all of the hypotypes group,Daxx expression cases were 3, 3, 2, 2, 0, 0 in turns. The rate was 75%, 75%, 50%, 66.67%, 0%, 0% in turns. For there was only 1 case in AML-M6 and 1 in AML- M7, make chi square test among the groups of M2, M3, M4, M5. the diference among them was no significance (P>0.05).
     1.6 The CR rate of the positive group(56.3%) was lower than the negative group(91.7%). The diference was significant (P<0.05).
     2 The expression of E2F1 in bone marrow cell
     2.1 The positive rate of E2F1 protein in 40 acute leukemia patients(57.5%) was significantly higher than in 20 control cases(20%) (χ2=7.576, P<0.05).
     2.2 The positive rate of E2F1 protein in AML(64.7%) and in ALL patients(52.2%) were basically the same, there was no significant difference between them(P=0.59, P>0.05).
     2.3 The positive rate of E2F1 protein in ALL-L1(33.3%) and in ALL-L2 patients(55%) were basically the same, there was no significant difference between them(P=0.59, P>0.05).
     2.4 There was no difference between the expression of E2F1 protein in ALL high risk(ALL-HR) patients(71.4%) and those stsndard risk (ALL-SR)cases(56.3%) (P=0.657,P>0.05). The positive rate of E2F1 protein in ALL-HR group and the rate of ALL-SR group were all significantly higer than the rate of control group(20%) (P<0.05).
     2.5 There were 17 patients with acute myeloblastic leukemia (AML). In all of the hypotype group,Daxx expression cases were 3, 3, 3, 2, 0, 0 in turns. The rate was 75%, 75%, 75%, 66.67%, 0%, 0% in turns. For there was only 1 case in AML- M6 and 1 in AML- M7, make chi square test among the group of M2, M3, M4, M5. The diference was no significance (P>0.05).
     2.6 the CR rate was not significant between the group of negative(69.6%) and positive(88.2%) (P>0.05).
     3 In 40 patients with acute leukemia, the expression of Daxx was positive correlated with the expression rate of E2F1,by the method of correlation analysis (χ2=14.339, P <0.05).
     Conclusions:
     1 High expression level of Daxx and E2F1 in childhood acute leukemia of newly diagnosed, it indicates that they could be used as a detective index.
     2 Daxx expression in AML was higher than in ALL, which indicates that Daxx is correlated with the classification of acute leukemia.The remission rate of negative group which expressed Daxx in AL was higher than the positive group. It indicates that Daxx may be an index of clinical prognostic in childhood AL.
     3 The experiment shows that Daxx and E2F1 are direct correlation. They were possibily cooperated in the process of childhood acute leukemia genesis and growth.
引文
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