72例急性白血病免疫学与细胞遗传学研究

Study on the Immunology and Cytogenetics of 73 Cases with Acute Leukemia

目的评价免疫学与细胞遗传学联合检测在急性白血病(AL)分型中的意义。方法采用CD45/SSC双参数散点图设门方法进行三色/四色流式细胞术免疫表型分析、R显带技术进行染色体分析。结果形态学分型与免疫学检查符合率为89.0%,有2例形态学拟诊为M7亚型的AML经免疫分型确诊,3例形态学拟诊为M3亚型的AML经染色体检查除外M3亚型;AML患者较特异性抗原表达为CD13(90.0%),CD33(94.0%),染色体异常率55%,其中特异性染色体异常占59%。伴t(15;17)染色体易位M3特异性表达CD13(100%)、CD33(100%)。M2b特异性表达CD19(100%)、CD34(100%)与t(8;21)染色体易位(100%)。M5易有CD14(25%)表达与t/del(11)(q23)染色体异常(50%)。髓系中易见淋系相关抗原表达,常见为CD7(24.0%),CD19(12%),CD10(6.0%)。CD7阳性AML患者染色体异常率达73%,显著高于CD7阴性AML患者(P<0.05);B-ALL患者染色体异常率83%,特异性染色体异常率53%。T-ALL患者染色体异常率71%,特异性染色体异常率60%。淋系中亦可合并髓系抗原表达,常见为CD13(52.0%),CD33(35%)。结论免疫学分型结合染色体检查可提高AL的诊断准确性、判断预后、揭示细胞生物学特征。特殊类型AL如M0、M3、M7等的诊断必须依赖免疫分型与染色体检查。

Objective To To evaluate the clinical significance of combined detection of immunophenotype and cytogenetics in the diagnosis of acute leukemia. Methods Immunophenotyping was performed by three/four color flow cytometry analysis with CD 45/SSC and karyotype analysis was performed by R banding technique, respectively. Results The coincidence rate was 89.0% between morphology and immunology, lrrcounophenotyping corrected two cases misdiagnosed for M7 and chromosoree examination corrected 4 cases misdiagnosed for M3 of acute myeloid leukemia （AML） by morphology, respectively. CD13 （92.0%） and CD33 （94.0%） was specifically expressed in AML who had 55% donal chromosome abnormality, including 59% specific donal chromosome abnormality. CD13 （100%） and CD33 （100%） was specially expressed in M3 with t （15; 17） translocation. CD19 （100%）, CD34 （100%） and t （8; 21） translocation was specially expressed in M2b. CD14 （25%） was specially expressed in M5 who bad 50% t/del （11q23） clonal chromosome abnormality. Lymphoid lineage associated antigents CD7 （24.0%）, CD19 （12%）, CD10 （6.0%） were easily found in AML. It was 73% that the ratio of clonal chromosome abnormality in CD7＋ AML, which was obviously higher than that in CD7- AML （P〈0.05）. B-ALL had 83% clonal chromosome abnormality, including 53% specific clonal chromosome abnormality, which were 71% and 60% in T-ALL, respectively. Myeloid lineage associated antigents CD13 （57.0%）, CD33 （38%） also could existed in ALL. Conclusion The combination of immunophenotype and chromosome examination is helpful to diagnosing AL, evaluating prognosis and revealing the characteristics of cell biology. The diagnosis of the special types such as M0, M3 and M7 of AL must depend on immunophenotype and chromosome analysis.