急性白血病复发外周血白血病细胞的流式细胞术检验分析

Flow cytometric analysis of peripheral blood leukemic cells in relapse of acute leukemia

目的分析急性白血病(AL)患者外周血白血病细胞流式细胞术检测情况,为分析AL的临床疗效和预后提供参考。方法采用流式细胞术检测87例AL患者(急性髓细胞白血病53例、急性淋巴细胞白血病34例)外周血标本,同时检测骨髓细胞形态学变化。结果急性髓细胞白血病检测的灵敏度为95.6%、特异度为34.5%、阳性预测值为81.3%;急性淋巴细胞白血病检测的灵敏度为87.3%、特异度为45.6%、阳性预测值为68.9%,差异均有统计学意义(P<0.05);检出微小残留病变阴性19例,24个月后复发率为26.31%,微小残留病变阳性68例,24个月后复发率为86.76%,两者复发率比较差异有统计学意义(P<0.05);在所有微小残留病变阳性患者中,高表达者复发率(88.23%)高于低表达者(47.09%),差异有统计学意义(P<0.05)。结论流式细胞术检测外周血白血病细胞对诊断AL复发和指导临床用药有重要意义。

Objective To analyse status of peripheral blood leukemic cells detected by flow cytometry in patients with acute leukemia（AL）,and to provide references for evaluating clinical efficacy and prognosis of AL.Methods The peripheral blood specimens of 87 cases of patients with AL,including 53 cases of patients with acute myelocytic leukemia and 34 cases of patients with acute lymphoblastic leukemia,were detected by using flow cytometry,morphological changes in bone marrow cells were detected,as well.Results The sensitivity,specificity and positive predictive value in determination of acute myelocytic leukemia was 95.6%,34.5% and 81.3% respectively,and those in acute lymphoblastic leukemia was 87.3%,45.6% and 68.9% respectively,statistically significant differences were found in sensitivity,specificity and positive predictive value（P〈0.05）.A total of 19 cases with negative minimal residual disease had recurrence（26.31%）after 24 months,and 68 cases with positive minimal residual disease had recurrence（86.76%）after 24 months,and the recurrence rate between the two groups was statistically significant（P〈0.05）.Among all patients with positive minimal residual disease,the recurrence rate in patients with high expression level of minimal residual disease（88.23%）was higher than that in patients with low expression level of minimal residual disease（47.09%）,and the difference was statistically significant（P〈0.05）.Conclusion Flow cytometric analysis of peripheral blood leukemic cells may has significance for diagnosing relapse of AL and guiding clinical medication.