成人急性白血病患者骨髓中血管生成的病理观察

Study on bone marrow angiogenesis in patients with acute leukemia

目的:探讨成人急性白血病(AL)患者骨髓中的血管生成情况与疾病发展的关系。方法:应用EnVision免疫组织化学二步法,检测122例次成人AL患者骨髓中的微血管数,分析治疗前、后骨髓微血管数的差异性及其与患者部分实验室检查指标、临床疗效的相关性。结果:抗CD34和抗血管性血友病因子(vWF)抗体分别标记所得骨髓微血管数差异无显著性(P=0.402)。骨髓微血管数在化疗后获得完全缓解(CR)的患者中为(48.4±18.6)个/mm2,显著低于初发患者(103.1±38.6)个/mm2(P<0.01);化疗后未获CR的患者中为95.0(41.0～159.0),无显著下降(P=0.35);而在缓解后复发的患者中升高至(92.9±32.9)个/mm2,与初发时相比差异无显著性(P=0.44)。化疗后CR患者的骨髓微血管数仍高于对照组(35.7±5.3)个/mm2(P=0.02)。急性髓细胞性白血病(AML)和急性淋巴细胞性白血病(ALL)患者初发时骨髓微血管数与初发时的骨髓原始细胞百分数呈正相关(r=0.399,0.525;P=0.009,0.030)。结论:不同类型成人AL患者骨髓中均存在血管新生现象。血管新生可能参与AL的病理发展过程。

Objective To investigate the relationship betwee n bone marrow angiogenesis and the progression of acute leukemia.Methods The statu s of bone marrow angiogenesis in122patients with human acute leukemia in differe nt stages were elucidated by an EnVision two-step immunohistochemical staining method and compared with10patients with non-ma-lignant hemopathy as controls.T he differences of bone marrow microvessel counts during different stages of the disease were observed and their relationship between some laboratory variables a nd response to chemotherapy were also analyzed.Results There was no significant differences between microvessel counts labeled by anti-CD34and anti-vWF antibo dies(P=0.402).Bone marrow microvessel counts in patients of complete remission a fter chemotherapy were significantly lower than those of newly diagnosed patient s without treatment(P<0.01).Moreover,no significant decrease of the count was fo und in non-remis-sion patients(P=0.35);but the counts of microvessel in the re lapsed patients increased to the level of the newly diagnosed patients.However,m icrovessel counts in remission patients were still significantly higher than tha t of the controls(P<0.01).Bone marrow microvessel counts were positively correla ted with percentage of marrow myeloblasts both in acute myeloid leukemia and acu te lymphocytic leukemia samples(r=0.399,0.525;P=0.009,0.030).Conclusion Angio genesis in adult pa-tients with acute leukemia of different types might be invo lved in the pathological progression of acute leukemia.