流式细胞术诊断急性混合细胞白血病临床意义探讨

Clinical Significance of Flow Cytometry in the Diagnosis of Acute Mixed Cell Leukemia

目的对急性混合细胞白血病临床诊断中流式细胞术的应用价值进行探讨。方法方便选择该院2014年1月-2017年12月收治的初发急性白血病患者416例,应用流式细胞仪和三色荧光标记抗体检测免疫表型。结果 416例初发急性白血病患者,28例(6.7%)为混合细胞白血病(MAL),其中20例(71.4%)B/髓系表达,6例(21.4%)T/B共表达,2例(7.1%)T/髓共表达;FAB分型诊断为急性淋巴细胞白血病(ALL)142例,62例纯淋系抗原表达,80例(56.3%)淋系伴髓系抗原表达(My+ALL);FAB分型诊断为急性髓细胞白血病(AML)246例,158例纯髓系抗原表达,88例(35.8%)髓系伴淋系抗原表达(Ly+AML);MAL28例,c CD3、CD79a、MPO表达比例分别为100.0%、100.0%、64.3%。MAL28例中表达CD34患者26例(92.9%)。18例(81.8%)CD117表达。结论实际中单纯通过细胞形态学无法准确诊断MAL、My+-ALL、Ly+-AML,流式细胞术免疫分型可弥补FAB分型不足,准确进行白血病细胞的分型诊断,为进一步开展临床治疗提供有效依据。

Objective To investigate the application value of flow cytometry in the clinical diagnosis of acute mixed cell leukemia. Methods A total of 416 patients with initial acute leukemia admitted to this hospital from January 2014 to December 2017 were convenient selected and enrolled. The immunophenotype was detected by flow cytometry and trichrome fluorescent antibody. Results Of the 416 patients with newly diagnosed acute leukemia, 28 cases(6.7%) were mixed cell leukemia(MAL),in cluding 20 cases(71.4%) were B/medullary, 6 cases(21.4%) were co-expressed, and 2 cases(7.1%) T/myeloid co-expression;FAB typing diagnosis of 142 cases of acute lymphoblastic leukemia(ALL), 62 cases of pure lymphoid antigen expression, 80 cases(56.3%) of lymphoid system with myeloid antigen expression(My+ALL) FAB classification diagnosis of acute myeloid leukemia(AML) in 246 cases, 158 cases of pure myeloid antigen expression, 88 cases(35.8%) myeloid with lymphoid antigen expression(Ly + AML);MAL 28 cases, c CD3, CD79 a, MPO expression ratios were100.0%, 100.0%, and 64.3%, respectively. In MAL28 patients, 26 patients(92.9%) expressed CD34, 18 cases(81.8%) had CD117 expression. Conclusion In practice, MAL, My+-ALL and Ly+-AML cannot be accurately diagnosed by cell morphology alone. Flow cytometry immunophenotyping can make up for the deficiency of FAB typing and accurately diagnose the classification of leukemia cells, providing effective basis for further clinical treatment.