[Diagnosis of adult Philadelphia chromosome-like acute lymphoblastic leukemia by fluorescence in situ hybridization]

目的

建立应用荧光原位杂交技术（FISH）筛查成人Ph样急性淋巴细胞白血病（ALL）的体系。

方法

根据Ph样ALL的遗传学特征，设计了针对ABL1、ABL2、JAK2、EPOR、CRLF2、CSF1R、PDGFRB、P2RY8等基因断裂重排的FISH探针；对BCR-ABL1、ETV6-RUNX1、MLL基因断裂重排和E2A断裂重排均阴性的B-ALL，采用FISH进行Ph样ALL筛查，并结合流式免疫表型、靶向二代测序突变检测和RNA测序进行Ph样ALL诊断分析。

结果

2016年1月至2019年4月，南方医院血液科收治189例成人B-ALL，经FISH和（或）PCR检测，BCR-ABL1、ETV6-RUNX1、MLL断裂重排或E2A断裂重排阳性者共83例；其余106例患者接受Ph样ALL FISH探针筛查，其中，12例（11.3％）检出典型的Ph样ALL特异基因断裂重排，2例检出基因缺失。经RNA测序进一步验证，FISH检测Ph样ALL基因断裂重排结果灵敏度为71.4％，特异度为95.8％。综合免疫表型、靶向二代测序突变检测和RNA测序，共诊断融合基因阳性Ph样ALL 14例（13.2％）。

结论

FISH技术检测Ph样ALL具有较高的特异性，结合免疫表型和测序技术可完善诊断体系。

[Expression and significance of serum hepatocyte growth factor and myeloperoxidase in patients with obstructive sleep apnea hypopnea syndrome]

Objective:The aim of this study is to explore the expression and significance of serum HGF and MPO in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) in adults. Method:Ninety-six cases of OSAHS patients diagnosed by PSG were divided into 3 groups: Heavy, medium and light according to the range of AHI; 32 cases of outpatients were healthy persons as the control group. The serum HGF and MPO were determined by ELISA; HGF and MPO were measured after comprehensive treat with CPAP in patients with severe OSAHS, and the correlation between HGF, MPO and PSG were analyzed. Result:①With the severity of OSAHS patients increased, the serum levels of HGF and MPO increased gradually (F=119.006, 25.138; P<0.05); The concentration of HGF and MPO in each group showed that there was no significant difference between the two groups compared with the control group (P>0.05); The rest of the two groups were significantly different (P<0.05). ②There was no correlation between serum levels of HGF, MPO, BMI and age in OSAHS patients (P>0.05). The change of serum concentration was positively related to the two. All were negatively correlated with AHI, and positively correlated with LSaO₂ (P<0.05). ③LSaO₂ of 32 patients with severe OSAHS of has significantly increased after 3 months of comprehensive treatment, AHI and peripheral blood HGF, MPO levels were significantly reduced (P<0.05). The amylin and myeloperoxidase concentrations of blood after 6 months of treatment were significantly lower than those of 3 months after treatment (P<0.05), which still increased compared with the control group. Conclusion:Surgery combined with CPAP treatment can significantly reduce the degree of hypoxia and cardiovascular damage in OSAHS patients, which was significantly correlated with the treatment time. Combined detection of serum HGF and MPO concentrations in patients with OSAHS has a certain clinical value in judging the condition and curative effect and evaluating the cardiovascular damage.

[Clinical analysis of adult Philadelphia chromosome-positive acute lymphoblastic leukemia with p16 gene deletion]

目的

探讨p16基因缺失在成人Ph染色体阳性急性淋巴细胞白血病（Ph⁺ ALL）中的临床意义。

方法

回顾性分析80例Ph⁺ALL伴p16基因缺失患者的临床特征、免疫表型、细胞遗传学、分子生物学改变及其预后。

结果

31.3% Ph⁺ALL患者合并p16基因缺失；p16基因缺失组与非缺失组相比，初诊时高白细胞计数（WBC≥30×10⁹/L）更常见，高表达CD20，更易出现附加染色体异常，其中以累及7、8、19号染色体以及der（22）较为常见；两组诱导缓解率比较差异无统计学意义（P=0.033），p16基因缺失组患者治疗3个疗程后获BCR-ABL融合基因主要分子学反应（MMR）率和完全分子学反应（CMR）率均明显低于非缺失组（P值分别为0.034和0.036），且复发率明显高于非缺失组（P=0.033）；p16基因缺失组使用伊马替尼联合化疗者和使用达沙替尼联合化疗者的MMR、CMR率及复发率差异均无统计学意义（P值均>0.05）；p16基因缺失组患者3年总体生存（OS）率及无病生存（DFS）率分别为37.1%和12.4%，显著低于非缺失组的54.1%和45.9%（P值分别为0.037和0.026）；25例p16基因缺失患者中14例行异基因造血干细胞移植（allo-HSCT），其中位OS时间为21个月，明显长于非移植组患者的12个月（P=0.030）。

结论

成人Ph⁺ALL伴p16基因缺失患者预后相对较差，二代酪氨酸激酶抑制剂不能明显改善其疗效，但allo-HSCT能够改善部分患者的生存，明确p16基因缺失状态对于评估预后和指导临床治疗有重要意义。

[Clinical significance of cytogenetic monitoring in chronic myeloid leukemia]

Objective: To analyze the association of cytogenetic abnormalities with the prognosis of chronic myeloid leukemia (CML) patients in tyrosine kinase inhibitors (TKI) era. Methods: Karyotype analysis of chromosome G-banding was carried out in 387 newly diagnosed CML patients by short-term culture of bone marrow cells. The correlation of cytogenetic abnormalities and CML progression was explored in combination with ABL tyrosine point mutations. Result: Of 387 patients with positive BCR-ABL fusion gene assayed by fluorescence in situ hybridization (FISH) technique, 94.1% (364/387) patients were Ph positive and 5.9% (23/387) Ph negative; 320 patients (87.9%) had a translocation t (9;22) (q34;q11) and 5 (1.4%) a variant translocation t (v;22) . Additional cytogenetic aberrations (ACA) at diagnosis were found in 10.7% (39/387) Ph(+) patients, major route ACA in 22 (56.4%) cases and minor route ACA in 15 (38.5%) cases and 2 patients (5.1%) lacked the Y chromosome (-Y) ; 23.4% (71/303) patients occurred ACA during TKI treatment and the most frequent abnormalities were abnormal chromosome numbersd, which were likely associated with high proportion of disease progression (χ(2)=168.21, P<0.001) and ABL tyrosine point mutations (χ(2)=29.04, P<0.001) . Newly diagnosed CML-CP patients with t (9;22) (q34;q11) had a longer event-free survival (EFS) and disease-free survival (DFS) rates than that of patients with ACA (P=0.037; P=0.003) , while the overall survival (OS) had no significant differences (P=0.209) . As for CML-CP patients that occurred ACA during TKI therapy would have a marked low OS, EFS and DFS (all P<0.001) compared with no ACA occurred patients. Survival of advanced patients that occurred ACA were dramatically reduced. Conclusion: ACA often emerged during the disease progress in CML patients, regular and timely detection of chromosomes karyotype and ABL tyrosine point mutations during TKI treatment was important for therapeutic evaluation, progress and prognosis of CML.

[Clinical research of differences of volume of pharyngeal cavity between normal healthy subjects and patients with severe obstructive sleep apnea hypopnea syndrome]

Objective:To investigate the differences of volume of pharyngeal cavity between normal healthy subjects and patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS)before and after surgery and its application value in assessment of surgical curative effect.Method:Forty-four healthy male adults were included in normal group.Thirty-eight patients with severe OSAHS diagnosed by polysomnography were included in experimental group(OSAHS group). Volume of pharyngeal cavity, oropharynx and laryngopharynx measured by acoustic pharyngealmetry and AHI, obstructive apnea frequency and the lowest oxygen saturation recorded by PSG monitor were all obtained in normal groups and experimental groups before and 3 months after the surgery. All the data are statistically analyzed. Result:Volume of pharyngeal cavity,AHI,obstructive apnea frequency and lowest oxygen saturation of patients in experimental group were all improved after surgery compared with pre-operation(P<0.01). Conclusion: The measurement of pharyngeal cavity volume is helpful to the quantitative analysis of upper airway structure and determine the stenosis location, it is also useful to guide surgery and evaluate the curative effect of the surgery.

The water-soluble component of Salvia miltiorrhiza Bge can promote macrophage synthesis of C4 in vivo and in vitro

A water-soluble component extracted from Salvia miltiorrhiza Bge has been used for many years in traditional Chinese medicine ('huo xie hua yu') for the treatment of the hyperviscosity syndrome. We demonstrate here that this extract promotes macrophage proliferation in vitro and enhances macrophage synthesis of the C4 component of complement. No increase in synthesis of other complement components by macrophages was observed. In a group of 20 patients with the hyperviscosity syndrome treated with an aqueous extract of Salvia, serum levels of C4 rose significantly over the course of treatment (mean pretreatment level 37.4 mg%, mean posttreatment level, 43.5 mg%; p < 0.01). The rise in C4 levels closely correlated with the disappearance of the patients' clinical symptoms.