Sharma Subhadra, Pati H P
Department of Laboratory Medicine (Haematology), All India Institute of Medical Sciences, New Delhi.
J Assoc Physicians India. 2006 Jun;54:453-7.
Red cell enzymes were assayed in a total of 67 patient including 24 patients with AML (19 relapse, 5 remission), 16 patients with ALL (10 relapse, 6 remission), 22 patients with CML and 5 patients with blastic CML. Diagnosis of leukemia was based on clinical presentation, peripheral blood smear and bone marrow examination (as per FAB classification). PK activity was significantly high in case of CML and blastic CML (p<0.01). Red cell HK was high in all leukemia subtypes. There was no alteration in red cell G6PD. Notably there was no PK deficiency in AML or G6PD deficiency in ALL. Activities of G6PD and PK could be correlated in cases of CML, AML, (p<0.05) and ALL (p<0.01) i.e. when there was increased activity of G6PD, PK activity also tended to be higher. HK activity showed a positive correlation with PK and G6PD activity in cases of CML (p<0.05), however in acute leukemia there was no such correlation. Alteration of enzyme activities among red cells in leukemia occurred only during relapse. At the time of remission there has been no significant alteration in any of the enzyme activities. It would therefore, appear that enzyme alterations seen in leukemia patients is due to abnormal pluripotent stem cell that has given to a leukemia cell. The fact that enzyme alterations have primarily occurred at the time of relapse would further substantiate that abnormalities of red cell enzymes may be the result of a derivation some circulating red cells from the abnormal pluripotent stem cell. With the recovery of normal stem cells function during remission, enzyme abnormalities tend to become normal.
共对67例患者的红细胞酶进行了检测，其中包括24例急性髓系白血病患者（19例复发，5例缓解）、16例急性淋巴细胞白血病患者（10例复发，6例缓解）、22例慢性髓系白血病患者和5例急变期慢性髓系白血病患者。白血病的诊断基于临床表现、外周血涂片和骨髓检查（按照FAB分类标准）。慢性髓系白血病和急变期慢性髓系白血病患者的丙酮酸激酶（PK）活性显著升高（p<0.01）。所有白血病亚型的红细胞己糖激酶（HK）均升高。红细胞葡萄糖-6-磷酸脱氢酶（G6PD）无变化。值得注意的是，急性髓系白血病患者不存在PK缺乏，急性淋巴细胞白血病患者不存在G6PD缺乏。在慢性髓系白血病、急性髓系白血病（p<0.05）和急性淋巴细胞白血病（p<0.01）病例中，G6PD和PK的活性具有相关性，即当G6PD活性增加时，PK活性也往往较高。在慢性髓系白血病病例中，HK活性与PK和G6PD活性呈正相关（p<0.05），然而在急性白血病中不存在这种相关性。白血病患者红细胞中的酶活性改变仅发生在复发期间。缓解期时，任何酶活性均无显著改变。因此，似乎白血病患者中观察到的酶改变是由于产生白血病细胞的异常多能干细胞所致。酶改变主要发生在复发时这一事实将进一步证实红细胞酶异常可能是异常多能干细胞衍生出一些循环红细胞的结果。随着缓解期正常干细胞功能的恢复，酶异常往往会恢复正常。
