苌哲宗　余红岚　费樱

[摘要] 目的 探讨血清胸苷激酶1（TK1）水平变化对不同类型儿童急性白血病（AL）的诊断价值及临床意义。 方法 选取贵州医科大学附属医院及贵阳市儿童医院2015年10月～2017年9月86例儿童AL患者为研究组，分为急性B细胞型淋巴细胞白血病（B-ALL）组38例，急性髓系白血病（AML）组26例和急性T细胞型淋巴细胞白血病（T-ALL）组22例。同时将急性淋巴细胞白血病（ALL）患儿分为标危组21例、中危组19例和高危组20例，另设86例健康体检儿童为对照组。空腹抽取静脉血，检测各组的血清TK1水平。 结果 B-ALL组、AML组以及T-ALL组血清TK1水平均高于对照组，T-ALL组血清TK1水平高于AML组，AML组血清TK1水平高于B-ALL组，差异均有统计学意义（P < 0.05）。高危组血清TK1水平高于中危组，中危组TK1水平高于标危组，差异均有统计学意义（P < 0.05）。 结论 检测血清TK1水平对儿童AL的筛查和实验室诊断有重要临床参考价值；血清TK1的水平与ALL患儿的临床危险分级有关，可作为其危险分级的一项参考指标。

[关键词] 急性白血病；急性B细胞型淋巴细胞白血病；急性T细胞型淋巴细胞白血病；急性髓系白血病；胸苷激酶1

[中图分类号] R729 [文獻标识码] A [文章编号] 1673-7210（2018）04（b）-0071-04

[Abstract] Objective To study the diagnostic value and clinical significance of serum thymidine kinase 1 （TK1） levels in different types of children with acute leukemia （AL）. Methods A total of 86 children with AL from the Affiliated Hospital of Guizhou Medical University and Guiyang Children′s Hospital from October 2015 to September 2017 were selected as the study group， they were divided into acute B-cell lymphoblastic leukemia （B-ALL） group （38 cases）， acute myeloid leukemia （AML） group （26 cases） and acute T-cell lymphoblastic leukemia （T-ALL） group （22 cases）. At the same time， children with acute lymphoblastic leukemia （ALL） were divided into standard risk group （21 cases）， intermediate-risk group （19 cases） and high risk group （20 cases）， meanwhile 86 healthy children were selected as the control group. Fasting venous blood was collected and serum TK1 levels were measured. Results The levels of serum TK1 in B-ALL group， AML group and T-ALL group were higher than that of control group， the level of serum TK1 in T-ALL group was higher than that of AML group， the level of serum TK1 in AML group was higher than that of B-ALL group， with the statistically significant differences （P < 0.05）. The level of serum TK1 In the high-risk group was higher than that of the intermediate-risk group， the level of serum TK1 in the intermediate-risk group was higher than that of the standard risk group， with the statistically significant differences （P < 0.05）. Conclusion Detection of the level of serum TK1 has an important clinical reference value in the screening and laboratory diagnosis of AL in children. The level of serum TK1 is related to the clinical risk grade of children with ALL， which can be used as a reference index for its risk classification.

[Key words] Acute leukemia； Acute B-cell lymphoblastic leukemia； Acute T cell lymphoblastic leu？鄄kemia； Acute myeloid leukemia； Thymidine kinase 1

急性白血病（Acute leukemia，AL）是来源于造血系统的恶性肿瘤性疾病，原始细胞在骨髓异常增生和聚集并抑制正常造血，导致贫血和血小板减少。原始细胞也可侵犯髓外组织，如脑膜、性腺、胸腺、肝、脾或淋巴结等，引起相应病变。临床表现可有发热、胸骨疼痛、无力、皮肤出现紫癜等；外周血计数白细胞数量增高、正常或减少，镜检可发现有原始或幼稚细胞。根据受累的细胞类型，AL可以分为急性淋巴细胞白血病（acute lymphoblastic leukemia，ALL）和急性髓系白血病（acute myeloid leukemia，AML）两大类[1]。胸苷激酶（thymidine kinase，TK）是DNA补救合成途径的限速酶，TK1作为TK的一种亚型，存在于细胞浆中[2]。长期以来，TK被认为仅在细胞周期的S期的DNA复制过程中发挥作用。……