CD25表达在急性髓系白血病中的临床分析

发布时间：2018-01-05 13:31

本文关键词：CD25表达在急性髓系白血病中的临床分析　出处：《郑州大学》2016年硕士论文　论文类型：学位论文

更多相关文章： CD25 急性髓系白血病 临床特征 预后

【摘要】：背景急性白血病(acute leukemia,AL)是血液系统最常见的恶性肿瘤,起病急,进展快,病情凶险,死亡率高。急性髓系白血病(acute myeloid leukemia,AML)是AL主要类型之一,是起源于造血干细胞的高度异质性的恶性克隆性疾病,髓系白血病细胞发育成熟过程中由于各种致病因素的作用而阻滞于不同的分化发育阶段,导致不同的AML亚型,其临床表现及疾病的预后转归往往不相同。目前临床上急性髓系白血病的诊断与分类主要包括FAB分类和WHO的MICM分类,需从形态学、免疫表型、细胞遗传学、分子生物学等各方面综合考虑。随着单克隆抗体和流式细胞术(Flow Cytometry,FCM)的发展和广泛应用,免疫分型已成为重要的实验室检查,不仅在白血病的诊断分类方面有重要意义,为危险度分层、预后判断提供重要的依据,对指导治疗也有一定的作用。许多文献报道AML常伴随表达一些淋系相关抗原,如deoxynucleotidyl transferase(Td T)、CD9、CD7等,Td T和CD7在AML中异常表达时常与不良预后有关。CD25在AML的表达是独立的不良预后因素,有助于AML的危险分层,而国内关于CD25在AML中表达的意义报道尚少,因此有待进一步探究。本文对我院2014年9月至2015年12月283例初治的AML患者临床资料进行回顾性分析,观察AML伴CD25表达的临床特征和临床疗效。目的观察CD25在AML的表达情况,探讨CD25~+AML患者临床特征及治疗反应,评估其预后价值。研究对象和方法收集2014年9月至2015年12月期间就诊于郑州大学第一附属医院的283例初诊的AML(非APL)患者。全部病例均完善骨髓形态学分析、组化染色、免疫表型测定、细胞遗传学及分子生物学等检查,依据FAB标准和WHO标准诊断和分类。应用流式细胞术检测白血病细胞表面CD25表达情况,根据CD25表达结果,将AML患者分为CD25~+AML组和CD25-AML组。回顾性分析两组患者(基于CD25的表达)的临床特征及治疗效果。所有患者随访至2015年12月31日或死亡、失访日期。结果1.CD25~+AML患者分布:283例AML患者中44例(15.55%)白血病细胞表达CD25抗原。CD25在急性单核细胞白血病(M5)中的表达率(28.05%)较其他白血病亚型高,差异具有统计学意义(P0.05)。2.CD25~+AML患者的临床特征:CD25~+AML与CD25-AML患者在发病年龄、HGB计数及PLT计数方面无统计学差异(P0.05)。与CD25-AML患者相比,CD25~+AML患者多见于女性,初诊时WBC计数、外周血原始细胞比例和骨髓原始细胞比例均增高(P0.05)。3.CD25~+AML患者的免疫表型特征:共检测30个白血病相关抗原。与CD25-AML患者相比,CD25~+AML患者高表达的抗原有CD11b、CD36、CD4、CD22和CD123;低表达的抗原是CD38和CD56(P0.05)。所检测的其他抗原在两组白血病细胞表达比例上差异无统计学意义(P0.05)。4.CD25~+AML患者的疗效分析:与CD25-AML患者相比,CD25~+AML患者CR率显著降低,第1个疗程CR率分别为49%和23.08%(c2=6.021,P=0.014),第2个疗程CR率分别为75.93%和44.44%(c2=7.493,P=0.006)。CD25~+AML患者较CD25-AML患者OS缩短(c2=24.554,P=0.000)。5.CD25表达与染色体核型的关系:CD25~+AML患者多发生在正常核型中(65.71%)。在CD25~+AML患者中,中危核型组与高危核型组相比较,OS差异无统计学意义(c2=3.194,P=0.071)。6.CD25表达与FLT3-ITD突变的关系:CD25~+AML伴FLT3-ITD突变发生率(60%)显著高于CD25-AML伴FLT3-ITD突变发生率(9.15%),差异有统计学意义(c2=44.948,P=0.000)。FLT3-ITD突变阳性的AML患者中,CD25~+AML组总体生存期(OS)显著低于CD25-AML组,差异有统计学意义(c2=4.078,P=0.043)。结论1.CD25~+AML多发生在正常染色体核型、M5亚型中。伴CD25表达的AML患者多见于女性,初诊时WBC计数、外周血原始细胞比例和骨髓原始细胞比例均增高。2.CD25是独立于染色体核型的AML不良预后因素,伴CD25表达的AML患者完全缓解率低、生存期短。3.CD25~+AML伴FLT3-ITD突变发生率高,伴CD25表达的FLT3-ITD~+AML患者预后更差。
[Abstract]:Background: acute leukemia (acute, leukemia, AL) is the most common malignant tumor of blood system, acute onset, rapid progression, dangerous disease, high mortality. Acute myeloid leukemia (acute myeloid leukemia, AML AL) is one of the main types, is the origin of hematopoietic stem cells to a high degree of heterogeneity of malignant clonal diseases myeloid leukemia cell maturation due to various pathogenic factors and arrest in different development stages of differentiation, leading to different AML subtype, prognosis and the clinical manifestations and prognosis of the disease is often not the same. The MICM classification in clinical diagnosis and classification of acute myeloid leukemia mainly includes FAB classification and WHO, to from the morphology, immunophenotype, cytogenetics, consider all aspects of molecular biology. With the monoclonal antibody and flow cytometry (Flow Cytometry, FCM) the development and wide application, immunophenotyping has become Laboratory examination is important, not only has important significance in the diagnosis and classification of leukemia, risk stratification, provide an important basis for prognosis, also have a certain role in guiding treatment. It has been reported that AML expression is often accompanied by some lymphoid associated antigens, such as deoxynucleotidyl transferase (Td T), CD9, CD7, Td T and CD7 in AML abnormal expression often associated with a poor prognosis in.CD25 AML expression were independent adverse prognostic factors that contribute to AML risk stratification, and the significance of domestic reports about the expression of CD25 in AML is less, therefore needs to be further explored. In this paper, the clinical data of AML patients in our hospital from September 2014 to December 2015 283 patients were retrospectively analyzed. The clinical features and clinical efficacy of AML with CD25 expression. Objective To observe the expression of CD25 in AML, to investigate the clinical characteristics and treatment of patients with CD25~+AML to assess the response Prognostic value. During the research object and methods from September 2014 to December 2015 in 283 cases of the First Affiliated Hospital of Zhengzhou University, AML (non APL) patients. All cases were complete bone marrow morphology analysis, immunohistochemistry, immunophenotyping, cytogenetics and molecular biology examination, according to the FAB standard and WHO standard of diagnosis and classification expression. Flow cytometry was used to detect leukemia cell surface expression of CD25 CD25, according to the results, the AML patients were divided into CD25~+AML group and CD25-AML group. A retrospective analysis of two patients (CD25 expression based on the clinical characteristics and treatment). All patients were followed up to December 31, 2015 or death, lost follow-up date. Results in patients with 1.CD25~+AML distribution: 283 cases of AML patients in 44 cases (15.55%) leukemia cells expressing CD25 antigen.CD25 in acute monocytic leukemia (M5) in the expression rate (28.05%) than other white Blood disease subtype, the difference was statistically significant (P0.05) the clinical characteristics of patients with.2.CD25~+AML: CD25~+AML and CD25-AML were no significant difference in age, HGB count and PLT count (P0.05). Compared with CD25-AML patients, CD25~+AML patients are more common in women, early diagnosis of WBC count, the proportion of the proportion of peripheral blood progenitor cells the original and bone marrow cells were higher (P0.05) immunophenotypic characteristics of.3.CD25~+AML patients: a total of 30 leukemia associated antigen detection. Compared with CD25-AML patients, patients with high expression of CD25~+AML antigen CD11b, CD36, CD4, CD22 and CD123; low expression of antigen is CD38 and CD56 (P0.05) antigen detection in the other. Two groups of leukemia cells showed no significant difference on the ratio (P0.05) analysis of the curative effect of.4.CD25~+AML patients compared with CD25-AML patients, CD25~+AML patients with CR was significantly lower, first courses of CR rates were 49% and 23 8% (c2=6.021, P=0.014), second cycles of CR were 75.93% and 44.44% (c2=7.493, P=0.006).CD25~+AML patients than in CD25-AML patients (c2=24.554, P=0.000) OS shortened the relationship between.5.CD25 expression and chromosome karyotype: CD25~+AML patients occurred in normal karyotype (65.71%). In CD25~+AML patients, intermediate group and karyotype the karyotype of high-risk groups compared, there was no significant difference of OS (c2=3.194, P=0.071) and the relationship between the expression of the FLT3-ITD mutation in.6.CD25: CD25~+AML with FLT3-ITD mutation rate (60%) was significantly higher than that of CD25-AML with FLT3-ITD mutation rate (9.15%), the difference was statistically significant (c2=44.948, P=0.000).FLT3-ITD mutation positive AML patients, CD25~+AML group overall survival (OS) was significantly lower than that of CD25-AML group, the difference was statistically significant (c2=4.078, P=0.043). Conclusion 1.CD25~+AML occurs in normal chromosome karyotype, M5 subtype. The expression of CD25 in AML patients with rare In women, initial WBC count, the proportion of the proportion of peripheral blood cells and bone marrow cells were the original original increased.2.CD25 is AML independent prognostic factor in karyotype, with the expression of CD25 AML in patients with complete remission rate is low, short survival time.3.CD25~+AML with FLT3-ITD mutation rate, the prognosis of FLT3-ITD~+AML patients with CD25 expressed more.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R733.71

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