FCM免疫表型分析在急性早幼粒细胞白血病MICM分型诊断中的意义

Clinical Significance of FCM Immunophonotype Analysis on MICM Classification Diagnosis in Patients with Acute Promyelocytic Leukemia

目的探讨急性早幼粒细胞白血病流式细胞术(FCM)免疫表型分析及其在MICM分型诊断中的临床意义。方法 FCM免疫表型分析采用流式细胞术多参数荧光标记抗体检测方法,对63例临床最终诊断为急性早幼粒细胞白血病(APL)患者的骨髓形态、免疫分型、遗传学、分子生物学等检测结果进行综合分析。结果 63例APL其FAB分析结果,56例为M3a型,6例为M3b型,1例为AML不除外M3;免疫表型分析结果显示CD33、CD13、CD117、MPO表达阳性率分别为100%、95.2%、92.1%和96.8%,大多数APL不表达CD34、HLADR,CD15、CD11b的表达均为部分或极少部分细胞的弱表达。染色体核型分析结果显示3例为正常核型、2例未见分裂相、1例因可分析细胞数极少而无法分析、57例可见特异性t(15;17)异常,其中有11例核型分析除可见t(15;17)异常外7例还伴有额外异常、4例伴有其它复杂异常。分子生物学检测结果显示63例均可见PML/RARa融合基因阳性。结论在APL的MICM分型诊断中,FCM免疫表型分析虽然不是诊断APL的独立指标,但可以为APL的快速鉴别与诊断提供依据。

Objective To investi gate the clinical significance of FCM immunophonotype analysis on MICM classification diagnosis in patients with acute promyelocytic leukemia.Methods FCM immunophonotye analysis was performed with multiparameter fluorescence labeling method.Marrow morphology,immunophonotye,genetic testing results and molecular biology results were analyzed synthetically in 63 patients with APL immunophenotype.Results FAB results in 63 cases with APL showed that 56 cases were M3 a,6 cases were M3 b and 1 case with AML.Immunophonotype analysis showed that the expression positive rates of CD33,CD13,CD117,MPO were 100%,95.2%,92.1% and 96.8%,respectively,and most APL patients did not express CD34,HLA-DR while CD15 and CD11b showed weak expression in some cells.Karyotype analysis showed that normal in 3 cases,no split phase in 2 cases,specific t（15;17）abnormity in 57 cases,（15;17）abnormity with other abnormities in 11 cases,other complicated abnormitiesin 4 cases.Molecular biological analysis showed PML/RARa fusion gene positive in 63 cases.Conclusion In MICM classification diagnosis of APL,morrow morphology is important but the FCM is the necessary supplementary method.Though FCM immunophonotype is not the independent index,it may provide the fast and accurate base for diagnosing the APL joint detection of FCM immunophonotype and MICM classification can improve the detection rate and accuracy.