目的 探讨Wilms瘤基因(WT1)在白血病、淋巴瘤及多发性骨髓瘤患者中的表达差异及其临床意义.方法 选取77例白血病、29例多发性骨髓瘤和30例淋巴瘤患者进行研究,采用荧光定量PCR技术检测三组骨髓中WT1基因的表达水平并进行比较分析.结果 白血病患者的WT1基因水平(0.105 ±0.019)显著的高于多发性骨髓瘤患者(0.027±0.008)和淋巴瘤患者(0.026±0.010)且差异有统计学意义(P<0.05),多发性骨髓瘤患者和淋巴瘤患者的WT1基因表达水平差异无统计学意义(P>0.05).治疗后,白血病患者的WT1基因水平(0.062±0.016)显著的低于初诊的白血病患者(0.157±0.012)且差异有统计学意义(P<0.05),治疗后的多发性骨髓瘤患者和淋巴瘤患者与初诊的多发性骨髓瘤患者和淋巴瘤患者的WT1基因表达水平差异无统计学意义(P>0.05).结论 WT1在白血病患者表达水平较淋巴瘤、多发性骨髓瘤患者呈显著的升高,同时治疗后白血病患者的WT1基因表达水平较初诊白血病患者呈显著降低.%Objective To investigate the expression and clinical significance of Wilms tumor gene (WT1) in patients with leukemia,lymphoma and multiple myeloma.Methods Seventy-seven leukemia patients,29 multiple myeloma patients and 30 malignant lymphoma patients were selected as the research objects from Affiliated Hospital of Hubei Polytechnic University.The expression levels of WT1 gene in three groups of bone marrow were detected by fluorescence quantitative PCR technique,and three groups' expression levels of WT1 gene were compared and analyzed.Results The level of WT1 gene of leukemia patients (0.105 ± 0.019) was significantly higher than those of multiple myeloma patients (0.027 ± 0.008) and lymphoma patients (0.026 ± 0.010) (P < 0.05).The expression levels of WT1 gene of multiple myeloma patients and lymphoma patients were not statistically significant (P > 0.05).The expression level of WT1 gene of leukemia patients (0.062 ± 0.016) was significantly lower than that of newly diagnosed leukemia patients (0.157±0.012) and the difference was statistically significant (P <0.05).Differences were not significant between multiple myeloma patients and lymphoma patients after treatment and those newly diagnosed in the level of WT1 gene (P > 0.05).Conclusions WT1 expression levels were significantly higher in patients with leukemia than those with lymphoma and multiple myeloma,and the level of WT1 gene expression in patients with leukemia after treatment was significantly lower than the newly diagnosed leukemia patients.
image.so.comWilms瘤是儿童最常见的肾脏恶性肿瘤。随着各项医疗手段的发展,Wilms瘤患儿生存率有了很大提高。研究表明,Wilms瘤因不同的组织学分型具有不同的预后。加深对肿瘤分子层面的认识能够使我们更好地了解肿瘤的生物学特性并对不同肿瘤进行区分,以帮助指导儿童Wilms瘤的治疗和预后判断。本文就儿童Wilms瘤在分子分型标志物研究方面的进展作一综述。
www.so.com目的 分析Wilms瘤患儿生存预后的影响因素并构建预测列线图.方法 回顾性分析本院186例Wilms瘤患儿的临床资料及预后资料.用Cox比例风险回归模型分析影响患儿总体生存期的因素,通过所得因素用R3.5.1软件的rms安装包绘制出列线图,用Bootstrap自抽样法进行内部验证,通过一致性指数(C-index)评估列线图对Wilms瘤患儿生存预测的准确性.绘制ROC曲线分析列线图模型预测Wilms瘤患儿生存预后的价值,计算ROC曲线下面积(AUC).结果 186例患儿均得到有效随访,3年生存率和5年生存率分别为74.7%和72.0%.Cox多因素分析结果显示,年龄(OR = 1.745)、发病部位(OR = 1.886)、肿瘤大小(OR = 2.290)、COG 分期(OR= 2.340)和病理分型(OR =0.375)是影响Wilms瘤患儿生存预后的独立因素(P均<0.05).用上述5个因子绘制列线图,C-index为0.741.3年总体生存率和5年总体生存率的列线图校准曲线接近45°对角线,提示列线图预测生存率与实际生存率较为接近.列线图预测3年死亡预后的AUC为0.835(95%CI:0.811～0.921),预测5年死亡预后的AUC为0.818(95%CI:().802-0.917).结论 年龄、发病部位、肿瘤大小、COG分期是影响Wilms瘤患儿生存预后的独立因素,根据上述因素构建的列线图可较为准确地预测Wilms瘤患儿的生存预后.
wenku.so.com目的探讨成人卵巢原发Wilms瘤合并畸胎瘤成分的临床病理学特征、诊断、鉴别诊断。方法观察成人卵巢原发Wilms瘤合并畸胎瘤成分的临床特点,采用免疫组化EnVision两步法检测WT1、PAX8、CKpan、desmin、S-100、Ki-67等的表达,分析Wilms瘤及畸胎瘤成分治疗的敏感性,并复习相关文献。结果患者右侧卵巢大小8 cm×8 cm×7 cm,包膜较脆伴破裂。肿瘤由胚芽、上皮及间叶3种成分组成,以未分化胚芽为主,见幼稚小管及分化型腺管,局灶间质呈横纹肌形态。胚芽成分强表达WT1,而分化型上皮和间质成分均不表达。上皮表达CKpan及PAX8,横纹肌分化细胞表达desmin,软骨成分表达S-100。胚芽成分Ki-67增殖指数约60%。患者术后6、9、12个月CT示盆腹腔多发结节,右下腹壁和脐旁结节。病理诊断为转移性Wilms瘤,以胚芽成分为主;术后辅以化疗(顺铂+依托泊苷+博来霉素,长春新碱+更生霉素+环磷酰胺)。结论成人卵巢原发Wilms瘤发生率极低,合并畸胎瘤成分的病例诊断具有复杂性及挑战性,需明确各成分占比,指导临床精准治疗。
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