急性双表型白血病诊断标准的探讨

Detection of criteria for diagnosis of biphenotypic acute leukemia

目的探讨急性双表型白血病(BAL)的诊断标准。方法对400例急性白血病(AL)初诊患者骨髓标本进行免疫分型,分别用Catovsky(1991年)和EGIL(1998年)新标准对其评分,筛选出BAL及伴淋/髓系表达的AL并将其分为4组进行分析:Ⅰ组积分≥2分;Ⅱ组积分>2分;Ⅲ组积分=2分;Ⅳ组积分0.5～1.5分。结果Ⅰ组和Ⅱ组白细胞中位数、肝脾淋巴结肿大例数均明显高于Ⅳ组,差异有统计学意义(P<0.05),Ⅲ组白细胞中位数、肝脾淋巴结肿大例数与Ⅰ组和Ⅱ组相比差异无统计学意义(P>0.05),与Ⅳ组相比差异有统计学意义(P<0.05);CR率分别为34.4%,37.5%,38.5%,65.0%。Ⅰ组、Ⅱ组CR率与Ⅳ组相比差异有统计学意义(P<0.05),Ⅲ组CR率与Ⅰ组,Ⅱ组相比差异无统计学意义(P>0.05),与Ⅳ组相比差异有统计学意义(P<0.05)。结论EGIL(1998年)标准评分较Catovsky(1991年)标准科学,但过于严格,该组结果表明,积分为2分病例在生物学特性上与BAL相符,而不同于伴淋/髓系表达AL,EGIL(1998年)标准以≥2分为界可能更为合理。

Objective To detect the criteria for diagnosis of biphenotypie acute leukemia （BAL）. Methods Immunophenotyping was performed on medullary specimens of 400 AL patients The scoring systems proposed by Catovsky（ 1991 ）and EGIL group（ 1998）was adopted to classify the quality eases of BAL and myeloid antigen-positive acute lymphoblastie leukemia （My＋ALL）/lymphoid antigen-positive acute myeloid leukemia（Ly＋AML） into four groups： seore≥2（group Ⅰ ）, 〉2（group Ⅱ ）, 2（group Ⅲ ）, and 0.5 - 1.5（group Ⅳ ）.Results ① The median of leucocytes and incidences of enlargement of liver spleen and lymphnodes in group Ⅰand Ⅱ were obviously higher than the items in group Ⅳ, the difference was significant （P 〈0.05）. The difference of the items mentioned previously between group Ⅲ and groups Ⅰ, Ⅱ was not significant （P 〉 0.05）, while the difference between group Ⅲ and group Ⅳ was significant （P 〈0.05）. ②Complete remission （CR）rates in these four groups were as follows： 34.4 %, 37.5 %, 38.5 %, 65 %. The difference of CR rate between groups Ⅰ, Ⅱ and group Ⅳ made sense in statistics （P〈0.05）,as well as that in group Ⅲ and group IV （P 〈0.05）, while which did not occur between group Ⅲ and groups Ⅰ, Ⅱ （P 〉0.05）. Conclusions The new scoring system proposed by EGIL （1998） was more scientific than the system proposed by Catovsky （1991）, but it is too strict on the other hand.Because the results showed that the group of patients （score=2） biologically coincided with BAL and differed from the AL presented by My＋ALLtLy＋AML, it seemed to be more reasonable to classify the results by using the point （seore≥2） in the new scoring system （EGIL, 1998）.