急性髓系白血病免疫表型特征及其临床意义

  本文关键词：急性髓系白血病免疫表型特征及其临床意义，由笔耕文化传播整理发布。

        目的：探讨成人急性髓系白血病细胞免疫表型与预后的关系。方法：148例急性白血病初治患者，其中急性髓系白血病（acute myeloid Leukemia,AML）140例，急性混合型白血病（mixed aleukemia, MAL）8例。采用流式细胞术方法分析患者的免疫表型。然后按白血病不同类型给予标准诱导缓解方案化疗：AML予DA或IA方案（M3除外）；M3采用ATRA或ATRA+As2O3（全反式维甲酸、三氧化二砷）联合化疗方案；MAL采用TOAP、DOLP方案，并观察其治疗效果。分析比较各免疫表型（CD13、CD33、CD64、CD34、HLA-DR、CD56、CD11b、CD64、CD14等）阳性患者与阴性患者之间的完全缓解率（completeremission）、 AML中伴淋系抗原表达者（Ly+-AML）与无伴淋系抗原表达者（Ly--AML）间的完全缓解率是否存在差异。结果：1．本组148例AML患者中，根据细胞形态学特征不能分型的6例，经过细胞免疫学检测，根据其细胞表面或胞浆抗原表达特点得以确诊，其中M12例，M54例。另4例形态学诊断为ALL患者，免疫学分型确诊为MAL。其余138例与FAB诊断相符，符合率93.24%。2．148例患者中，有8例MAL，140例AML。AML患者中，M4发病率最高，其次为M5、M2、M3、M1，而M6发病率最低。各种抗原表达阳性率由高到低依次为CD38、CD13、CD33、HLA-DR、CD64、CD34、CD11b、CD56、CD14；140例AML中伴淋系表达占49.3%（69例），69例LY+AML中淋系抗原最常见为CD7（43例）、其余依次为CD19（12例），CD4（9例子）、CD2（5例），CD20检测为阴性。M3中CD34及HLA-DR表达水平明显低于其他亚型白血病，CD56较常见表达。3．148例AL中，仅95例患者可判断疗效。95例白血病患者经诱导治疗后，54例取得完全缓解，总缓解率为56.84%；其中53例AMLCR，CR率57.61%（53/92）；1例MAL CR，CR率33.3%（1/3）。4．AML患者中，淋系免疫表型CD7+CR率明显低于CD7-患者CR率，两者间差别具统计学意义（P<0.05）；CD19+CR率高于CD19-CR率，两者差别具显著性（P<0.05）。92例AML患者中，Ly+-AML47例，CR率46.81%，Ly--AML42例，CR率68.89%，两者间差异具统计学意义（P>0.05）。5．CD7、CD19与CD34抗原表达一致性较高，且CD34、CD7双阳性患者CR率低于CD34+、CD7-患者的CR率，两者间存在统计学差异；而CD34、CD19双阳性患者CR率高于CD34+、CD19-患者CR率，差异有统计学意义；CD34、CD11b（成熟粒细胞抗原标志）双阳性患者CR率明显低于CD34+、CD11b-患者CR率，且差异有统计学意义；CD56、CD11b双阳性M5患者CR率低于双阴性M5患者CR率，但差异无统计学意义。6．祖/干细胞免疫表型CD34+-AML CR率（57.14%）低于CD34--AMLCR率（58.33%），两者间差别无统计学意义（P>0.05）；HLA-DR+-AMLCR率（57.58%）低于HLA-DR--AMLCR率（57.69%），两者间差别无统计学意义（P>0.05）；CD38+-AMLCR率（60%）高于CD38--AMLCR率（41.67%），差异无统计学意义。结论：1．免疫表型分析有助于确诊一些特殊类型的白血病，在急性白血病的诊断分型中有重要意义；急性髓系白血病CD13、CD33高表达，CD34、HLA-DR表达低下甚至缺如，，尤其非双阳性患者，可作为M3的较为特异的免疫学表型以协助诊断。2．AML可以表现为髓系抗原与CD7、CD19等淋系抗原共表达，结果显示Ly+AML患者的化疗疗效差；单一非淋系相关抗原的表达对于急性髓系白血病预后判断的意义仍需进一步探讨，而不同抗原异常同步表达（如CD34+CD7+、CD34+CD19+、CD34+CD11b+）对于白血病的预后判断具一定价值。3．CD56、CD11b作为M5的不良预后因素而有待关注；MAL具有髓系和淋系双重特征，疗效差。

    Objective:To explore the immunophenotyp of leukemia cells and its clinical significance inacute leukemia（AL）patients.Methods:There are148cases of acute leukemia patients, including140cases of acutemyeloid leukemia and8cases of acute mixed leukemia. The immunophenotype of allpatients were analyzed with flow cytometry. Acute myeloid leukemia （non-M3） weretreated with the regimen of DA or IA; M3were treated with ATRA or ATRA+As2O3（all-trans retinoic acid, arsenic trioxide）which combined with chemotherapy; MALwere treated with the regimen of TOAP or DOLP; and then observation of curativeeffect. Analyzing the difference of CR rate between lymphoid antigen positive AMLand lymphoid antigen negative AML, and the difference of CR rate between myeloidantigen positive AL and myeloid antigen negative AL.Results:1. Six cases in the group of148patients, which cann’t typed by the cellmorphology were diagnosed with immunological detection according to the cellsurface or intracellular antigen expression characteristics, including2cases of M1,4cases of M5. It was about93.24%equal with immHnophenotyping-diagnosis andFAB-diagnosis．2. In148patients, there were8cases of mixed leukemia,140patients with AML.In AML patients, M4incidence was the highest, followed by M5, M2, M3, M1, M6andminimum morbidity.In140patients with AML antigen expression from high to low asCD38、CD13, CD33, HLA-DR, CD64, CD34, CD11b, CD56, CD14; lymphoidantigen CD7, CD19,CD4,CD2express in AML, CD20is negative. The expressionlevel of CD34and HLA-DR in M3was significantly lower than the other subtypes ofAML, CD56more common. 3. The CR rate of AML is56.84%（53/93）, the rate of MAL is33.3%（1/3）.4. The CR rate of CD7+-AML was39.28%（11/28）, which was lower than65.63%（42/64） from CD7--AML（P<0.05）. The CR rate of CD19+-AML was91.67%（11/12）, which was higher than52.50%（42/80） from CD19--AML（P<0.05）.And, the CR rate of Ly+AML was46.81%（22/47）,while Ly-AML was68.89%（31/45）,there was statistical significance amony them（P<0.05）.5. CD34, CD7antigen expression of high consistency, and the CR rate in doublepositive patients is lower than the patients with CD34positive and CD7negative,there is significant difference between the two; while the CR rate in CD34, CD19double positive patients is higer than the patients with CD34positive and CD19negative, and the difference was statistically significant; CD34, CD11b doublepositive patients in remission rate higher than that of CD34+, CD11b-patients inremission rate, but the difference was not statistically significant.6. The CR rate of CD34+-AML was57.14%（32/56）, which was lower than58.33%（21/36） from CD34--AML（P>0.05）. The CR rate of HLA-DR+-AML was57.58%（38/66）, which was litter lower than57.69%（15/26） fromHLA-DR--AML（P>0.05）. And, the CR rate of CD38+-AML was60%（48/80）,whileCD38--AML was41.68%（5/12）, there was no statistical significance amonythem（P>0.05）.Conclusion:1.Immunophenotyping of leukemia cells could be helpful for classification ofsome specific type of acute leukemia and has important clinical significant ineva1uating the prognosis of AL.2.The expression of a single antigen for leukemia prognostic significance stillneeds a further study; expression of antigen abnormal synchronization for leukemiamay have some value（CD34+CD7+, CD34+CD19+, CD34+CD11b+）.3.CD56and CD11b have improtant significance in the diagnosis and prognosisof M5; Myeloid antigen and lymphoid antigen are positive in MAL, the curativeeffect of MAL is worse.

        急性髓系白血病免疫表型特征及其临床意义

中英文缩略词表4-5中文摘要5-7英文摘要7-8前言9-11材料与方法11-13结果13-20讨论20-27结论27-28参考文献28-30致谢30-31综述31-46    参考文献42-46

  本文关键词：急性髓系白血病免疫表型特征及其临床意义，由笔耕文化传播整理发布。