糖原染色在急性淋巴细胞白血病亚型诊断中的应用

Application of PAS staining in diagnosis of acute lymphoblastic leukemia subtype

目的分析急性淋巴细胞白血病(ALL)中糖原染色(PAS)的不同阳性率及分布形态及与ALL亚型(B型及T型)的关系,探索PAS在ALL亚型区分中的应用价值。方法 (1)对2009年以来每例急性白血病患者送检的骨髓涂片均加做过氧化物酶(POX)染色,将根据法国、美国、英国(FAB)协作组提出的急性白血病分型诊断标准诊断的ALL患者骨髓涂片与流式细胞术(FCM,流式)分型结果作回顾性比较,计算吻合率;(2)对上述ALL患者骨髓涂片加做PAS,计算PAS阳性率并描述其分布形态,比较PAS不同阳性率及分布形态与ALL亚型(B型及T型)的关系。结果 (1)根据FAB分型标准诊断ALL 57例,其中FCM证实ALL 56例(1例微分化型急性髓细胞白血病),与FCM吻合率为98.2%。(2)44例B-ALL中,PAS阳性38例(占86.4%),其中PAS阳性率大于或等于51.0%的32例(占72.7%)。12例T-ALL中,PAS阳性5例(占41.7%),其中PAS阳性率大于或等于51.0%的1例(占8.3%)。(3)38例PAS阳性B-ALL中,34例PAS颗粒(++～++++);5例PAS阳性T-ALL中,PAS颗粒均为(+)。结论 PAS阳性率大于或等于51%并且PAS呈粗颗粒状时,多数为B-ALL,PAS可作为ALL免疫亚型诊断的辅助手段。

Objective To investigate the significance of periodic acid Schiff（PAS） staining for ALL subtype diagnosis,we performed a study on variety of PAS positive rates and distribution in clinically submitted marrow smears in 2009.Methods All samples,which stained by POX,were shaped the correlation with ALL subtypes.The investigated samples all were diagnosed as ALL based on the FAB classification and flow cytometry respectively.Then,to compare the two results retrospectively and to calculate the concordance rate as well.After additional PAS reaction performed on all samples,figure out staining positive rate and describe the distribution shape accordingly.To combine these results to analyze the relevance with ALL subtypes（B-or T-）.Results 57 cases were diagnosed as ALL according to FAB classification standards,while 56 cases were ALL on the basis of flow cytometry results.The concordance rate was 98.2%;38 cases from the 44 cases of B-ALL were PAS positive（86.4%）,among which the positive rates of 32 cases were equal or greater than 51.0%（72.7%）;5 cases from 12 cases of T-ALL were PAS positive（41.7%）,which the positive rate of 1 case of them are equal or greater than 51.0%（8.3%）;The stained particles of 34 PAS positive B-ALL cases were from medium to strong titer（＋＋~＋＋＋＋）,while the stained particles of 5 PAS positive T-ALL cases were all weak titer（＋）.Conclusion When the PAS positive rate is equal or greater than 51.0% and the PAS staining present coarse stained particles simultaneously,the majority cases belong to the B-all subtype.Therefore,PAS staining can be applied in the ALL subtype diagnosis as an auxiliary assay.