82例急性早幼粒细胞白血病形态学及免疫表型特征分析

Acute promyelocytic leukemia cell morphology and immune phenotypic characteristics:An analysis of 82 cases

目的探讨急性早幼粒细胞白血病（acute promyelocytic leukemia,APL）患者的细胞形态及免疫表型特点。方法选取2010年8月-2014年3月于解放军总医院就诊的APL患者82例,采用流式细胞仪免疫荧光技术检测其白血病细胞免疫表型,并结合骨髓细胞形态检查进行分析。结果流式细胞分析应用CD45/SSC双参数散点图证实APL患者异常早幼粒细胞比例为45.6%-88.2%,形态学检查异常早幼粒细胞比例为50.5%-94.5%。其抗原阳性表达率及平均阳性细胞比例：CD33（100%、90.2%）,CD13（100%、85.3%）,CD9（85.4%、68.2%）,CD64（91.5%、67.4%）,CD117（65.9%、56.4%）,CD2（11.0%、36.2%）,CD11b（18.3%、30.5%）,CD16（0.0%、0.0%）,CD19（3.7%、26.3%）,CD15（9.8%、44.6%）,CD4（0.0%、0.0%）,CD56（17.1%、41.7%）,CD34（9.8%、40.4%）,CD3（0.0%、0.0%）,CD7（4.9%、34.2%）,CD10（0.0%、0.0%）,CD14（0.0%、0.0%）,CD20（0.0%、0.0%）,HLA-DR（12.2%、42.4%）。CD34^＋和（或）HLA-DR^＋组表达CD2、CD56抗原强度明显高于CD34^-和HLA^-DR-组（P〈0.05）。M3a型CD117抗原阳性表达率明显高于M3v型（P〈0.05）,M3v型CD34抗原阳性表达率明显高于M3a和M3b型（P〈0.01）。结论骨髓细胞形态学是诊断APL的基础,结合其免疫表型有助于提高确诊率及分析白血病细胞来源。

Objective To study the cell morphologic and immunophenotypic characteristics of patients with acute promyelocytic leukemia（APL）. Methods Flow cytometry instrument immunofluorescence technique was used to detect the immune phenotype of leukemic cells in 82 patients with APL, and bone marrow cell morphology inspection was also applied. Results The proportion of abnormal promyelocyte detected by morphologic examination was 50.5%- 94.5%, the proportion of abnormal promyelocyte detected by CD45/SSC gating was 45.6%- 88.2%. The antigen positive expression rate and the average ratio of positive cells were as follows： CD33（100%, 90.2%）, CD13（100%, 85.3%）, CD9（85.4%, 68.2%）, CD64（91.5%, 67.4%）, CD117（65.9%, 56.4%）, CD2（11.0%, 36.2%）, CD11b（18.3%, 30.5%）, CD16（0.0%, 0.0%）, CD19（3.7%, 26.3%）, CD15（9.8%, 44.6%）, CD4（0.0%, 0.0%）, CD56（17.1%, 41.7%）, CD34（9.8%, 40.4%）, CD3（0.0%, 0.0%）, CD7（4.9%, 34.2%）, CD10（0.0%, 0.0%）, CD14（0.0%, 0.0%）, CD20（0.0%, 0.0%.）, HLA-DR（12.2%, 42.4%）. CD2 and CD56 antigen expression was significantly higher in CD34^＋ and/or HLA-DR^＋group than in CD34^- and HLA-DR^- group（P〈0.05）. M3 a type CD117 positive antigen expression rate was significantly higher than M3 v type（P〈0.05）, M3 v type CD34 positive antigen expression rate was significantly higher than M3 a and M3 b type（P〈 0.01）. Conclusion Bone marrow cell morphology is the basis of the diagnosis of APL, and it will be helpful in improving the diagnosis accuracy and analysis of the source of leukemia cells if combing with immunophenotype.