Study On Relationship Between Fusion Genes,Immune Typing And Coagulation Function In Acute Myeloid Leukemia

Acute myeloid leukemia(AML)is a clinically common type of leukemia,mainly occurring in adults,whose incidence increases with age.AML is often accompanied by varying degrees of bleeding tendency,which can lead to changes in the coagulation mechanism of patients,imbalance between normal coagulation and anticoagulation,and easy formation of blood hypercoagulation or bleeding,an important cause of death.Therefore,rapid and accurate diagnosis of AML is very important.The MICMC diagnostic system,which is composed of cell morphology,immunotyping,cytogenetics,molecular biology and clinical efficacy typing,is of great value for the diagnosis and treatment of leukemia.The immunotyping mainly detects relevant immune molecules,and gene rearrangement test is an important molecular biological indicator to evaluate patients' condition and efficacy.There is a certain correlation between the two indicators.For example,CD25 is the signature antigen of fusion gene BCR/ABL1 in patients with B-cell acute lymphoblastic leukemia,and CD66c,CD13,CD10 and CD38 are related to BCR/ABL1.Currently,correlation research on the immune molecules and the fusion gene expression of AML patients is rare.This article selects FAB classification for incipient patients with AML,using flow cytometry to detect multiple immune classification immune molecules expression and fluorescence quantitative polymerase chain reaction(PCR)to detect PML-RARa fusion gene expression,in order to investigate the relationship between the PML-RARa fusion gene and immune molecules and its diagnosis efficiency onPML-RARa fusion gene,providingnew experimental basis for clinical diagnosis and treatment of AML patients.Due to the frequent occurrence of abnormal coagulation function in AML patients,the relationship between coagulation function and PML-RARa fusion gene is rarely reported in literature.This study aimsto analyze the relationship between PML-RARa fusion gene and coagulation function in AML patients,and provides experimental basis for clinical research and treatment of AML patients.Objective:To investigate the relationship between immune molecules and PML-RARa fusion gene in acute myeloid leukemia and the diagnostic efficacy of immune molecules for expression of PML-RARa fusion gene,and analyze the relationship between PML-RARa fusion gene and five coagulation function indexesin patients with incipientacute myeloid leukemia.Methods:120 patients with acute myeloid leukemia initially diagnosed with FAB from July 2016 to February 2019 in jingzhou central hospital were selected.The fusion gene PML/RARa was detected by fluorescence quantitative PCR,and the molecular expression of CDs were measured by flow cytometry.The patients were divided into two groups according to PML/RARa expression.The expression differences of CDs and their association with PML/RARa were analyzed.At the same time,120 cases of patients with acute myeloid leukemia were divided into PML-RARa fusion gene positive group(39 cases)and PML-RARa fusion gene negative group(81 cases),among which blood coagulation function index were measured,including prothrombin time(PT),activated partial thrombin time(APTT),fibrinogen(FIB),thrombin time(TT),and D-dimer(D-D).Moreover,the association betweenPML-RAR?fusion gene and blood coagulation functionindexes was analysed.Results:1.The rate of CD64 positive patients in PML/RARa positive group was as high as 75.0%,while the rates of CD34,HLA-DR and CD7 positive patients were 7.7%,7.7%and 0.0%,respectively.The rate of CD64 positive patients in the PML/RARa negative group was 28.6%,while the rates of CD7,CD34 and HLA-DR positive patients were 44.4%,77.8%and 63.0%,respectively,with significant statistical differences(P<0.05).The rate of CD64 positive cells in PML/RARa positive patients was higher than that in PML/RARa negative patients,and the rate of CD7,CD34 and HLA-DR positive cells was lower than that in PML/RARa negative patients.The rate of CD64,CD34 and HLA-DR positive cells was significantly different between the two groups(P<0.05).When the critical values of CD34,HLA-DR and CD64 were 10.7%,11.1%and 14.2%,respectively,the P value had significant statistical significance.At the same time,the above diagnostic thresholds had high accuracy(the area under the ROC curve was 0.84,0.84 and 0.83,respectively),and had good sensitivity and specificity for the diagnosis of positive PML/RAR?.2.There were statistically significant differences in the distribution of FIB,TT and D-D levels between the PML/RARa positive group and the PML/RARa negative group(all P<0.05),while there were no statistically significant differences in the distribution of APTT and PT levels(all P>0.05).Compared with the PML/RARa negative group,the AML patients in the PML/RARa positive group had elevated PT,TT and D-D levels and decreased FIB levels(all P<0.05).Through further correlation analysis,PML/RAR? fusion gene was positively correlated with TT and D-D,and negatively correlated with FIB.Conclusion1.CD34,HLA-DR and CD64 arestrongly correlated with PML/RARa fusion genes in patients with acute myeloid leukemia.2.The diagnostic thresholds of CD34,HLA-DR,and CD64 were 10.7%,11.1%,and 14.2%,respectively,which show good performance in the diagnosis ofrearranging of PML/RARafusion genes in patients with acute myeloid leukemia.3.TT,D-D and FIB levels are strongly correlated with PML/RARa fusion gene in patients with acute myeloid leukemia.4.Patients with positive PML/RARa fusion gene show elevated TT,D-D and decreased FIB levels,with a higher risk of abnormal coagulation and fibrinolytic system,which has a good guiding significance for the clinical treatment of patients with acute myeloid leukemia.