免疫表型在鉴别急性早幼粒细胞白血病与HLA-DR阴性急性髓系白血病中的应用

Application of immunophenotype analysis in distinguishing APL from HLA-DR negative AML

目的探讨免疫表型在急性早幼粒细胞白血病(APL)和HLA-DR阴性的急性髓系白血病(AML)之间的鉴别诊断中的价值。方法回顾性研究2014年至2024年间收治的42例APL患者和28例初治及复发的HLA-DR阴性AML患者。通过流式细胞免疫表型分析,比较两组患者CD64、MPO、CD7、CD11c、CD9、CD123等抗原的阳性表达率。利用χ2检验进行统计学分析,并应用ROC曲线评估CD9和CD123的表达模式,以及CD64^(+)MPO^(+)CD7^(-)CD11c^(-)对APL的诊断价值。结果AML组患者的CD64、CD9、MPO阳性率显著低于APL组,而CD11c、CD7阳性率显著高于APL组,差异具有统计学意义(P<0.05)。CD64^(+)MPO^(+)CD7^(-)CD11c^(-)的综合抗原积分表达模式在鉴别诊断APL方面的ROC曲线下面积(AUC^(ROC))为0.859,敏感性为93.8%,特异性为75.0%,CD9/CD123的鉴别诊断APL的AUC^(ROC)为0.919,敏感性为83.3%,特异性为84.0%;而联合应用CD9/CD123和综合抗原积分的诊断模式,AUC^(ROC)为0.955,敏感性为83.3%,特异性为100%。结论CD9/CD123表达模式及CD64^(+)MPO^(+)CD7^(-)CD11c^(-)联合应用可作为鉴别诊断APL与HLA-DR阴性的AML的重要依据.

Objective To investigate the diagnostic value of immunophenotype in distinguishing acute promyelocytic leukemia(APL)from HLA-DR negative acute myeloid leukemia(AML)using flow cytometry.Methods A retrospective observational study was conducted including 42 APL patients and 28 newly diagnosed or relapsed HLA-DR negative AML patients admitted to our hospital from 2014 to 2024.Immunophenotype analysis was performed on bone marrow aspirate samples using flow cytometry.The positive expression rates of CD64,MPO,CD7,CD11c,CD9,CD123 and other antigens were compared between the two groups using the Chi-square test.The diagnostic efficiency of the CD9/123 and CD64^(+)MPO^(+)CD7^(-)CD11c^(-)models for APL was evaluated using receiver operating characteristic(ROC)curves.Results The HLA-DR negative AML group exhibited significantly lower positive rates of CD64,CD9 and MPO(P<0.05),and higher positive rates of CD11c and CD7(P<0.05)compared to APL group.The CD64^(+)MPO^(+)CD7^(-)CD11cmodel had an area under the curve(AUC^(ROC))of 0.859,sensitivity of 93.8%and specificity of 75.0%for distinguishing APL.The CD9/CD123 expression pattern had AUC^(ROC)of 0.919,sensitivity of 83.3%and specificity of 84.0%for APL diagnosis.The combined CD9/123 and CD64^(+)MPO^(+)CD7^(-)CD11c^(-)model had AUC^(ROC)of 0.955,sensitivity of 83.3%and specificity of 100%.Conclusion The combined CD9/123 and CD64^(+)MPO^(+)CD7^(-)CD11c^(-)expression pattern may serve as a helpful tool for differentiating APL from HLA-DR negative AML.