[Clinical characteristics and prognosis of 34 cases of acute myeloid leukemia with FLT3 internal tandem duplication and MLL gene rearrangement]

目的

探讨同时伴FLT3-ITD突变及MLL基因异常的急性髓系白血病（AML）患者的临床特征及转归。

方法

回顾性分析34例同时伴FLT3-ITD突变及MLL基因异常的AML患者的临床资料，比较化疗、化疗加靶向药物治疗及allo-HSCT的疗效及影响因素。

结果

34例同时伴FLT3-ITD突变及MLL基因异常的AML患者占同期住院AML患者的2.02%。入院时WBC>30×10⁹/L的患者占63.6%，其中WBC>50×10⁹/L者占39.4%。FAB亚型中以M₅比例最高，占35.3%，染色体核型异常者达63.6%，其中复杂异常占12.1%。34例患者中仅有FLT3-ITD及MLL基因异常（双基因异常）者11例（32.4%），具FLT3及MLL以外的1种及1种以上的基因异常（多基因异常）者23例（67.6%）。34例患者2个疗程完全缓解（CR）率为29.4%，7例（20.6%）化疗≥3个疗程后CR，CR患者的早期复发率为52.9%。WBC>50×10⁹/L以及多基因异常的患者2个疗程CR率较低（7.7%、5.4%），其中具有3种以上基因异常的患者无一例CR。34例患者2年总生存（OS）率为28.8%（95%CI 13.5%~46.0%），2年无病生存（DFS）率为27.1%（95% CI 12.5%~44.0%）。18例仅使用化疗或化疗加靶向药物治疗的患者，17例在2年内死亡，1例放弃治疗后失访。接受allo-HSCT治疗的患者3年OS率为43.4%（95%CI 13.7%~70.4%），3年DFS率为42.7%（95% CI 13.4%~69.7%）。

结论

同时伴FLT3-ITD突变及MLL基因异常的AML患者FAB分型以M₅多见，常伴高白细胞血症、细胞遗传学异常及多基因异常。患者化疗缓解率低，早期复发率高，长期生存率低。高白细胞血症、多基因异常可能是此类患者疗效差的重要原因，allo-HSCT可改善患者的转归。

[Expression of secreted frizzled-related protein-1 in patient with oral submucous fibrosis]

Objective: To investigate the concentrations and clinical significance of secreted frizzled-related protein-1(SFRP1) insaliva and gingival crevicular fluid of patients with oral submucous fibrosis (OSF) as well as the expression of SFRP1 in patients' OSF buccal mucosa. Methods: Twenty OSF patients aged 20 to 40 years old were recruited and randomly divided into two experimental groups, of which were triamcinolone acetonide group and combined triamcinolone acetonide and salvia miltiorrhiza group, respectively. Ten healthy volunteers matchable in sex and age with the patients were recruited as control group. Concentrations of SFRP1 in saliva and gingival crevicular fluid were detected by enzyme-linked immunosorbent assay before and after a continuous treatment of 4 weeks. The visual analogue scale(VAS) pain scores and opening size were also recorded. The expression of SFRP1 in samples from OSF patients' buccal mucosa was also detected using immunohistochemical method. SPSS 16.0 was applied to analyze the results of the experiments. Results: The concentrations of SFRP1 in saliva and gingival crevicular fluid before treatment were (105.8±27.6) ng/L and (84.7±33.2) ng/L in triamcinolone acetonide group, and (86.6±23.2) ng/L and (97.0±23.2) ng/L in combining group, which were both significantly lower(P<0.01) than that in normal group([153.0±32.8] ng/L and [157.5±31.1] ng/L), respectively. The positive expression rate of SFRP1 in OSF group(10%[2/20]) was significantly lower than that of the control group(10/10)(P<0.01). After the treatment for 4 weeks, the concentrations of SFRP1 increased to (141.2±35.3) ng/L and (130.6±31.3) ng/L in triamcinolone acetonide group, and to (148.5±65.9) ng/L and (123.0±27.4) ng/L in combining group, which were both significantly higher than those of pre-treatment, respectively(P<0.01). Conclusions: The concentrations of SFRP1 in saliva and gingival crevicular fluid of OSF patients, which positively corelated to the expression of SFRP1 in OSF patients' buccal mucosa, were significantly lower than that of normal individuals and increased significantly after treatments of local injections of triamcinolone acetonide only or combined with salvia miltiorrhiza.