骨髓形态联合免疫分型检测对慢性淋巴细胞白血病诊断及预后价值研究

The research on the value of cell morphology combined with immunophenotyping test in the diagnosis and prognosis of chronic lymphocytic leukemia

目的:探讨慢性淋巴细胞白血病(CLL)患者骨髓形态、免疫表型特征,以及它们之间的关系。方法;采用流式细胞术对89例CLL患者骨髓或外周血标本进行免疫表型检测,依据细胞形态学分析将CLL患者分为典型CLL和混合型CLL两组,比较两组之间各抗原表达差异,并分析其对预后的影响。结果:89例CLL患者抗原表达阳性率由高至低依次为CD_(19)(98.9%)、HLA-DR(97.8%)、CD_5(88.8%)、CD_(20)(85.4%)、CD_(22)(71.9%)、CD_(23)(61.8%)、CD_(38)(39.3%)、FMC-7(11.2%)、CD_3(2.2%)。细胞形态学分型89例CLL中,典型CLL72例(80.9%),混合型CLL17例(19.1%)。CD_(38)在典型CLL及混合型CLL组间的阳性表达存在显著的统计学差异,CD_5、CD_(19)、CD_(20)、CD_(22)、CD_(23)、HLA-DR、FMC-7各抗原在两组间表达差异无统计学意义.预后分析显示混合型CLL生存期较典型CLL短(P<0.01),死亡患者与存活患者之间CD_(38)表达差异有明显的统计学意义。结论:细胞形态学结合免疫表型分析不仅是CLL诊断、鉴别诊断的主要手段,而且对预后判断具有重要价值。

Objective:To investigate cell morphology and immunophenotypes characteristics of CLL patients and to understand the relationship between them.Methods:Immunophenotyping of bone marrow and blood specimens was performed in 89 CLL patients by flow cytometry,meanwhile the patients were divided into the typical CLL group and the mixed CLL group according to the analysis of cell morphology.We compared the antigen expression differences between the two groups,and thus analyzed the impact of the differences on prognosis.Results:In all patients,the rates of antigen expression from high to low were CD_(19)(98.9%),HLA-DR(97.8%),CD_5(88.8%),CD_(20)(85.4%),CD_(22)(71.9%),CD_(23)(61.8%),CD_(38)(39.3%),FMC-7(11.2%)and CD_3(2.2%).For cell morphologic classification of 89 cases,72(80.9%)cases were typically CLL and 17(19.1%)cases mixed CLL.There was significant difference in the expression of CD_(38) between the typical CLL and mixed CLL group.There were no significant differences in the expressions of CD_5,CD_(19),CD_(20),CD_(22),CD_(23),HLA-DR,FMC-7between the two groups.Prognostic analysis showed that the survival time of mixed CLL patients was shorter than that of typical CLL patients(P<0.01),the difference of the expression of CD_(38) between the deceased and survived patients was statistically significant.Conclusion:The combination of cell morphology and phenotype analysis is not only the main means of CLL diagnosis and differential diagnosis,and also has great value for prognosis estimation.