CD56在急性白血病和骨髓增生异常综合征诊断中的作用

The role of CD56 antigen in acute leukemia and MDS

目的探讨CD56在急性白血病(AL)和骨髓增生异常综合征(MDS)中的表达及临床意义,观察CD56是否可以作为AL和MDS诊断及判断预后的重要标志。方法收集142例初治AL和MDS患者的资料,所有病例依据WHO(2008)诊断标准及FAB分类标准确诊。采用五色流式细胞仪分析细胞表面抗原,包括髓系、淋巴细胞系、巨核细胞系和红细胞系的代表性抗原,具体包括CD2、cCD3、CD3、CD4、CD5、CD7、CD8、CD10、CD20、CD19、CD79a、CD11b、CD13、CD14、CD15、CD33、CD34、CD45、CD56、CD61、CD64、CD71、CD117、HLA-DR、GlyA、MPO。通过流式细胞术了解CD56在不同细胞群中的表达情况,并结合骨髓形态学、流式细胞术、融合基因、染色体、骨髓活检等综合分析CD56在AL和MDS中的表达情况。结果①CD56主要表达于急性髓细胞白血病(AML)。CD56在AML和ALL中的表达阳性率分别为35.00%、3.70%,差异有统计学意义(P<0.05),CD56可作为区别AML和ALL的标志之一。CD56在AML-M2中表达最多。②CD56异常表达于原始细胞、粒细胞、单核细胞上,CD56阳性率依次为:原始细胞28.57%,粒细胞20.00%,单核细胞5.71%。③CD56+AL患者更易发生染色体异常、更易形成融合基因。107例AL患者中CD56+(29例)、CD56-(78例)染色体异常检出率为65.52%、28.21%,差异有统计学意义(P<0.05)。CD56+、CD56-融合基因检出率为58.62%、30.77%,差异有统计学意义(P<0.05),且以AML/ETO最多见。④35例MDS中CD56+(17例)、CD56-(18例)染色体异常检出率为64.71%、55.56%,差异无统计学意义(P>0.05);但CD56+患者多提示预后差,CD56-患者多提示预后相对较好。结论CD56是诊断AL、MDS和判断预后的重要标志。

Objective To investigate the CD56 expression in acute leukemia and myelodysplastic syndrome and its clinical significance,observe whether CD56 can be used as an important marker for AL and MDS diagnosis and prognosis.Methods 142 cases AL and MDS patients were recruited.All cases were diagnosed according to the WHO diagnostic criteria in 2008 and classified by the French-American-British group(FAB).Used five color flow cytometry instrument to analyze cell surface antigen,including the representative antigen of myeloid,lymphoid cell lines,giant cell line and red blood cell,including CD2,cCD3,CD3,CD4,CD5,CD7,CD8,CD10,CD20,CD19,CD79a,CD11b,CD13,CD14,CD15,CD33,CD34,CD45,CD56,CD61,CD64,CD71,CD117,HLA-DR,GlyA,MPO.Understood CD56 expression in different cells by flow cytometry,and comprehensively analyzed CD56 expression in AL and MDS with bone marrow morphology,flow cytometry,fusion gene,chromosome,bone marrow biopsy.Results①CD56 expression was mainly in acute myelogenous leukemia(AML).The expression of CD56 between AML and ALL was statistically significant(35.00%vs 3.70%,P<0.05),CD56 could be used as a marker of distinction between ALL and AML.CD56 was mostly expressed in AML-M2.②CD56 was abnormally expressed in the blast cells,neutrophils and monocytes,positive rate of CD56 was 28.57%,20.00%,5.71%respectively in blast cells,granulocyte,mononuclear cells.③CD56+patients were more prone to chromosome abnormalities,more easy to form the fusion gene.Among 107 patients,chromosome abnormality rate of CD56+and CD56-patients was 65.52%,28.21%respectively,there was significant difference(P<0.05).The fusion gene detection rate of CD56+and CD56-patients was 58.62%,30.77%,there was significant difference(P<0.05).AML-ETO was the most common.④Among 35 MDS patients,chromosome abnormality rate of CD56+and CD56-patients was 64.71%,55.56%respectively,there was no significant difference(P>0.05),CD56+patients had worse prognosis,CD56-patients had better prognosis.Conclusion CD56 is an important marker for the diagnosis and prognosis of AL and MDS.