目的 探討難治性急性淋巴細(xì)胞白血病（ALL）患兒治療效果與地塞米松治療敏感性的關(guān)系及耐藥機(jī)制。方法 回顧性分析榆林市第二醫(yī)院自2015年1月-2017年7月治療的105例難治性急性淋巴細(xì)胞白血病患兒臨床資料，根據(jù)不同治療敏感性分為敏感組與不敏感組?；純壕扇〉厝姿芍委?，劑量為7.5~10 mg/（m²·d），持續(xù)治療7 d后，給予標(biāo)準(zhǔn)化療方案。比較兩組化療第26天骨髓象、危險(xiǎn)度分級(jí)及地塞米松治療前后的外周血白細(xì)胞糖皮質(zhì)激素受體（GR）蛋白、GRαmRNA、Bcl-2蛋白家族促凋亡因子Bin蛋白、Bin mRNA表達(dá)水平；隨訪6個(gè)月，比較兩組完全緩解率、復(fù)發(fā)率、死亡率。結(jié)果 在105例難治性ALL患兒中，地塞米松治療敏感69例、治療不敏感36例。敏感組化療第26天骨髓象分型、危險(xiǎn)度分級(jí)均顯著優(yōu)于不敏感組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。敏感組地塞米松治療后GR蛋白、GRα mRNA、Bin蛋白、BinmRNA表達(dá)水平均顯著高于不敏感組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。敏感組完全緩解率顯著大于不敏感組，復(fù)發(fā)率、死亡率均顯著小于不敏感組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 難治性ALL患兒GR表達(dá)水平上調(diào)可增強(qiáng)地塞米松治療敏感性，放大地塞米松誘導(dǎo)細(xì)胞凋亡效應(yīng)，對于提高近期療效具有一定作用，值得進(jìn)一步研究應(yīng)用。

Objective To investigate the relationship between the therapeutic effect of dexamethasone and the sensitivity of dexamethasone in children with refractory acute lymphoblastic leukemia (ALL) and the mechanism of drug resistance. Methods The clinical data of 105 children with refractory ALL treated in Yulin NO. 2 Hospital from January 2015 to July 2017 were retrospectively analyzed, and divided into sensitive group and insensitive group according to the sensitivity of different treatments. All the children were treated with dexamethasone at a dose of 7.5-10 mg/(m²·d). After 7 days of continuous treatment, standardized treatment was given. Myelogram and risk grading on the 26th day of chemotherapy were compared between the two groups. And the glucocorticoid receptor (GR) protein, GRα mRNA, Bin protein, and Bin mRNA expression before and after dexamethasone treatment in peripheral blood were measured. After 6 months of follow-up, the complete remission rate, relapse rate, and mortality rate were compared between two groups. Results Among 105 children with refractory ALL, dexamethasone was sensitive to 69 patients and insensitive to 36 patients. On the 26th day after chemotherapy, the myelogram classification and risk grade of the sensitive group were significantly better than that of the insensitive group, and the differences were statistically significant (P<0.05). The expression of GR protein, GRα mRNA, Bin protein and Bin mRNA in the sensitive group after treatment with dexamethasone was significantly higher than that in the insensitive group (P<0.05). The complete remission rate in the sensitive group was significantly greater than that in the insensitive group, and the recurrence rate and mortality were significantly less than those in the insensitive group, differences were statistically significant (P<0.05). Conclusion Up-regulation of GR expression in children with refractory ALL may increase the sensitivity of dexamethasone treatment, amplify dexamethasoneinduced apoptosis, it has a role in improving the short-term curative effect, it is worth further research and application.