急性淋巴细胞白血病免疫分型的特点及其临床意义

The characteristics of immunophenotype in acute lymphoblastic leukemia and its clinical significance

目的:为了探讨急性淋巴细胞白血病(ALL)各亚型免疫分型的特点及其临床意义。方法:采用CD45/SSC双参数散点图设门,应用三色流式细胞术,对81 例ALL的初诊患者骨髓标本进行免疫分型,并对其中45例进行核型分析。结果:①B细胞系列的ALL(B ALL)中CD19表达最常见(阳性率为100%),而T细胞系列的ALL(T ALL)中CD5和CD7表达阳性率最高,均为90%;B -ALL和T- ALL都存在抗原交叉表达的现象;两组患者的完全缓解(CR)率差异无统计学意义(P>0.05);②伴髓系抗原表达的急性淋巴细胞白血病(My+ALL)比较常见,本组达到39.5%,常累及B淋巴系统(占My+ ALL的84.4%);各髓系抗原中以CD13 表达阳性率最高;此类患者的CR率较高,儿童CR率为72.2%,成人为78.6%;③急性杂合性白血病(HAL)的发病率为19.8%,以髓系、B系共同表达者居多;并且CD34表达阳性率较高(81.3%),该类患者CR率较低(儿童和成人分别为50%和40%);④CD34在B ALL,My+ALL和HAL中表达阳性率较高,而T ALL中少见(P<0.05)。结论:免疫分型在诊断特殊类型的ALL(如HAL,My+ALL)中具有显著优势;CD19和CD5诊断B- ALL和T- ALL的灵敏度较好,但特异性不高,存在抗原交叉表达;CD34和髓系抗原的表达与CR率无相关性,但在HAL,CD34的表达与CR率成负相关。

Objective:To study the characteristics of immunophenotype in ALL and its clinical significance.Method:Immunophenotyping was performed in 81 ALL patients by three-color flow cytometry analysis using CD45/SSC gating, meanwhile the cytogenetic analysis was performed in 45 patients.Result:①CD19 was the most commonly expressed of all B-lineage antigens detected, the positive rate was 100%; same as CD5 and CD7 for T-ALL. Both B-ALL and T-ALL overlapped in expression of lineage antigens. As for complete remission rate (CR rate),no obvious difference was found between T-ALL and B-ALL; ②The incidence of ALL with myeloid antigen expression (My+ALL) was 39.5%. CD13 was the most common as compared to other myeloid markers. My+ALL always involved in B-lineage ALL and the CR rate was higher (children and adults were 72.2% and 78.6% respectively); ③The incidence of HAL was high in our report ( 19.8%). Coexpression of B-lineage and myeloid-associated antigens was the most common subtype in HAL; The expression of CD34 was commonly seen in HAL patients ( 81.3%); The CR rate was low in HAL, 50% in children and 40% in adults; ④Compared with T-ALL, B-ALL, My+ALL, and HAL had higher positive rate of CD34 expression, the difference was significant (P< 0.05).Conclusion:Immunophenotyping was important in diagnosing special subtype of ALL (such as HAL and My+ALL); CD19 and CD5 were the most sensitive marker in diagnosing B-ALL and T-ALL, but less special, overlap was found in expression; No significant association was found between the expression of CD34 or myeloid antigen and CR rate, while low CR rate had been found in HAL patients, especially for those coexpressing CD34 antigen.