急性早幼粒细胞白血病143例免疫表型研究

Immunophenotypic Features in 143 Cases of Acute Promyelocytic Leukemia

为了探讨急性早幼粒细胞白血病(APL)免疫表型特征,以CD45/SSC设门,对143例APL进行多参数流式细胞术免疫分型,比较初发和复发时免疫表型变化。随机选择同期42例HLA-DR阴性的非APL的急性髓系白血病(AML)患者作为对照,其中31例CD34也为阴性,探讨其与初发APL的免疫表型的差异。结果表明:①初发APL中91.9%表现为CD34和HLA-DR共阴性,复发时CD34和HLA-DR阳性率增高(37.5%vs3.0%,37.5%vs3.9%)。初发APL组CD34阳性率低于DR-AML组(3.0%vs23.4%),初发APL组CD34即使阳性,其表达水平也较低(p<0.05)。②初发APL组CD33阳性率高于各对照组(97.0%vs75.0%,83.3%,83.9%),其表达水平亦高于各对照组(p<0.05)。③初发APL组淋系抗原中仅见CD2的表达,未见CD7的表达,而DR-AML组、CD34-/DR-AML组CD7阳性率分别为12.0%,6.5%,高于初发APL组(p<0.05)。结论:免疫表型检测可以为APL的快速诊断提供依据,对HLA-DR-的AML可以从CD34的表达与否、CD33的表达水平、淋系抗原表达情况以及SSC特征等方面与APL进行鉴别。

This study was aimed to investigate the immunophenotypic characteristics of acute promyelocytic leukemia （APL）. CD45/Side Scatter （SSC） gating strategy and multiparametric flow cytometry were used to determine immunophenotype of 143 patients with APL. The immunophenotypic features were compared between newly diagnosed APL patients and relapsed APL patients. 42 patients with HLA-DR^- （ non-APL AML, DR- AML） were randomly selected as controls. 31 out of 42 AML patients were CD34 negative, and their immunophenotypes were compared with those in newly diagnosed APL patients. The results showed that （ 1 ） CD34 and HLA-DR were both negative in 91.9% of newly diagnosed APL, while the positive rate of CD34 and HLA-DR elevated in relapsed cases （3.0% vs 37.5%, 3.9% vs 37.5% ）. The positive rate of CD34 in HLA-DR^- AML group was higher than that in newly diagnosed APL group （ 23.4% vs 3.0% ）. The positive level of CD34 in newly diagnosed APL group was lower than that in HLA-DR^- AML group; （2） the positive rate of CD33 in newly diagnosed APL group was higher than that in other groups（97.0% vs 75.0%, 83.3 %, 83.9% ）, as well as the the positive level of CD33 （p 〈 0.05 ）. （3） no lymphoid antigen other than CD2 was expressed in newly diagnosed APL group. The positive rate of CD7 was 9.5% in DR^- AML group and 6.5% in CD34^-/D^R- AML group, both were higher than those of newly diagnosed APL group （p 〈 0.05 ）. It is concluded that the immunophenotyping can provide proof to the rapid diagnosis of APL. For those patients with DR^- AML, it may be helpful to identify APL depending on following features： low or negative CD34 expression, homogeneous and bright expression of CD33, no lymphoid antigens other than CD2, higher SSC.