初诊儿童急性淋巴细胞白血病细胞形态学及免疫表型特征

Cell morphology and immunophenotype features of initial diagnosis of children with acute lymphoblastic leukemia

目的探讨儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)的细胞形态学及免疫表型特征,为其诊断及治疗提供依据。方法采用多参数流式细胞术(flow cytometry,FCM)对146例初发儿童ALL患者进行免疫表型分析,并结合骨髓细胞形态检查进行分析。结果流式细胞分析显示ALL患者原始和幼稚细胞比例在46.8%~91.4%,形态学检查原始和幼稚细胞比例在50.8%~94.5%。急性B淋巴细胞白血病(acute B lymphoblastic leukemia,BALL)患者高表达Cy CD79a(100.0%)、CD19(99.2%)、CD10(84.0%)、CD9(84.0%)、CD22(82.4%)抗原;急性T淋巴细胞白血病(acute T lymphoblastic leukemia,T-ALL)患者高表达Cy CD3(100.0%)、CD7(100.0%)、CD5(76.2%)、CD2(66.7%)、CD3(57.1%)、CD8(52.4%)抗原。146例儿童ALL患者中有54例(37.0%)表达髓系抗原(My Ag)。B-ALL患者髓系相关抗原表达总的阳性率为39.2%,与T-ALL(41.6%)比较,差异无统计学意义(P>0.05)。My Ag+组患者WBC≥50×109/L比例和CD34+比例均明显高于My Ag-组,差异有统计学意义(P<0.01)。结论骨髓细胞形态学是诊断ALL的基础,结合其免疫表型特征分析,对ALL的诊断及分型具有重要的价值。

Objective To investigate the cell morphology and immunophenotype features of children with acute lymphoblastic leukemia（ALL）,and we provide evidences for its diagnosis and treatment. Methods Multi-parameter flow cytometry（FCM）was performed to analyze the immunophenotype in 146 cases of children with ALL,and the morphological examination of bone marrow cells was performed. Results Analysis of flow cytometry demonstrated that the proportion of primary and naive cells in ALL patients was between 46.8% and 91.4%,and morphological examination of the original and naive cells was between 50.8% and 94.5%. High expression of Cy CD79a（100.0%）,CD19（99.2%）,CD10（84.0%）,CD9（84.0%）、CD22（82.4%）antigen were in B-ALL patients. High expression of Cy CD3（100.0%）,CD7（100.0%）,CD5（76.2%）,CD2（66.7%）,CD3（57.1%）,CD8（52.4%）antigen were in T-ALL patients. Expression of myeloid antigen（My Ag） in 146 cases of children with ALL was 54 cases（37.0%）. B-ALL patients with myeloid antigen expression of the total positive rate was39.2%,and compared with T-ALL（41.6%）,the difference was not statistically significant（P 0.05）. My Ag＋group of WBC≥50×109/L of percentage and the percentage of CD34＋were significantly higher than that in the My Ag-group,the difference were statistically significant between the two groups（P〈0.01）.Conclusion Bone marrow cell morphology is the basis of the diagnosis of acute lymphoblastic leukemia,combined with the analysis of the characteristics of its immune phenotype,the diagnosis and classification of ALL is of great value.