〔Abstract〕 Objective To observe the dynamic changes of reactive oxygen species(ROS), isocitrate dehydrogenase 2(IDH2) and sirtuin 3(SIRT3) in patients with acute myeloid leukemia(AML) before and after chemotherapy, and to explore the differences of ROS, IDH2 and SIRT3 levels in different AML patients and their application value in clinical diagnosis and efficacy evaluation. Methods Bone marrow and peripheral blood samples were taken from 20 newly diagnosed AML(non-APL) patients who had not received chemotherapy(new diagnosis group); bone marrow and peripheral blood samples were taken from 40 AML(non-APL) patients who had received chemotherapy(by Treatment group); 20 normal human bone marrow and peripheral blood samples were taken as control(control group). The expression of ROS in bone marrow mononuclear cells and mitochondria of bone marrow mononuclear cells in each group was observed under a fluorescence microscope, and the expressions of IDH2 and SIRT3 in peripheral blood of each group were determined by ELISA. The expression of AML1-ETO fusion gene in patients was summarized, and the expression of SIRT3 in different groups was compared. The expression of SIRT3 in different treatment effects and treatment courses in the treated patients were compared. Results The expression of mitochondrial ROS in bone marrow mononuclear cells and cells in the three groups was higher in the newly diagnosed group than that in the control group(P<0.05), and lower in the treated group than that in the newly diagnosed group(P<0.05). The expression of IDH2 in peripheral blood of the three groups was higher in the newly diagnosed group than that in the control group(P<0.000 1), and lower in the treated group than that in the newly diagnosed group(P<0.05). After peripheral blood samples were diluted 5 times, the expression of SIRT3 in the newly diagnosed group was lower than that in the control group(P<0.000 1); the expression of SIRT3 in the treated group was higher than that in the newly diagnosed group(P<0.01). The SIRT3 expression of fusion gene-positive patients was higher than that of fusion gene-negative patients; the SIRT3 expression of partial remission patients was higher than that of complete remission patients; the SIRT3 expression of patients with complete remission in the subgroup of previously treated patients was higher than that of patients with a longer treatment course than those with a short treatment course. Conclusion SIRT3 is an important protein that regulates metabolic function in the mitochondria of cells. Its expression is down-regulated in patients with acute myeloid leukemia, and the expressions of IDH2 and ROS increased accordingly. In AML, the abnormal expression of SIRT3 can accelerate the occurrence and development of tumor and reduce the therapeutic effect.