54例慢性淋巴细胞白血病的临床回顾性分析

Retrospective Clinical Analysis on 54 Cases of Chronic Lymphocytic Leukemia

目的:本研究旨在探讨慢性淋巴细胞白血病(CLL)的实验室检查特点及特征性临床表现。方法:利用血细胞分析仪、流式细胞术、骨髓形态分析及R显带技术等对我院2002年4月-2012年4月收治的54例慢性淋巴细胞白血病患者的相关临床资料如血细胞计数、骨髓形态、染色体及免疫表型等进行检测并对结果进行回顾性分析。结果:CLL多发于老年患者,男性多见,中位年龄65岁(45-82岁)。大部分患者初诊时可出现典型的临床表现,37例(68%)患者初诊时淋巴结大,49例(91%)初诊时白细胞≥10×109/L,淋巴细胞绝对值≥5×109/L。13例(24%)初诊时肝脾或者脾大,17例(31%)初诊时乏力、消瘦。34(63%)例患者可见典型的CLL免疫表型,CD5、CD19.CD23、CD20的阳性率分别为90%、87%、72%、67%。32例患者染色体检测结果表明:13q-2例,17p-2例,11q-1例,+12有1例,6q-1例,t(14,16)1例。2例患者发生了自身免疫性溶血性贫血(AIHA)。1例患者发生了Richter转化,肿大淋巴结活检显示部分区域为弥漫性大B细胞淋巴瘤,其高表达CD20、CD19、CD22。结论:慢性淋巴细胞白血病具有其典型的临床表现、免疫表型及遗传学改变,并且对诊断及治疗有重要意义。

Objective： To investigate the clinical manifestations and laboratory features of chronic lymphocytic leukemia （CLL）. Methods： Medical record of 54 patients from our institution with CLL diagnosed from April 2002 to April 2012 were retrospectively reviewed by hematology analyzer, including blood cell count, bone marrow morphology, chromosome and immunophenotype. Flow cy- tometer, bone marrow morphological analysis and r-banding techniques. Results： CLL is likely to occur in the elder patients. Male has an excess of attack rate over female. The median age was 65 （from 45 to 82）. Most of the patients had typical clinical manifestations when newly diagnosed, 37 cases （68%） with lymphadenectasis, 49 cases （91%） with hyperleucocyte （〉 10× 109/L） and increased lymphocyte （≥ 5 × 109/L）, 13 cases （24%） with hepatosplenomegaly, 17 cases （31%） with fatigue and emaciation, 34 cases （63%） with typical immunophenotype, the positive rate ofCD5, CD19, CD23 and CD20 was 90%, 87% ,72% and 67%, respectively. Chromosome results of 32 patients indicated that 2 cases with 13q-, 2 cases with 17p-, 1 cases with llq-, 1 cases with ＋12, 1 cases with 6q- and 1 cases with t （14,16）. Among 54 cases, two cases were complicated by autoimmune hemolytic anemia （AIHA）. 1 case was complicated by Richter transformation, tumid lymph node biopsy indicated that some regions progressed to diffuse large B cell lymphoma, highly expressing CD20, CD19 and CD22. Conclusion： The typical clinical manifestations, immunophenotype and genetic change help the diagnosis and treatment of chronic lymphocytic leukemia.