急性B淋巴细胞白血病的免疫表型表达特征及临床意义

发布时间：2018-08-26 16:41

【摘要】：目的:探讨急性B淋巴细胞白血病(B-ALL)免疫表型表达特征及临床意义。方法:采用流式细胞术(FMC)对初诊的50例BCR-ABL融合基因阴性的急性B淋巴细胞白血病患者进行免疫分型。观察急性B淋巴细胞白血病的免疫表型表达特征及临床意义。结果:50例患者中,B细胞抗原中CD19+表达率为84.00%,阳性表达率最高。T细胞抗原CD5、CD7可跨系表达。伴髓系抗原中CD13+表达率最高,表达率为48.00%。50例患者入院确诊后均进行诱导化疗,第一次化疗后完全缓解(CR1)率为76.00%,总有效率为86.00%。男性患者第一次化疗后CR1率为77.27%,总有效率为95.45%,女性CR1率及总有效率分别为75.00%、78.57%,男女两组CR1率、总有效率比较不具备统计学差别。依据年龄分为≥40岁和40岁两组,第一次化疗后≥40岁组CR1率为57.14%,总有效率71.42%,40岁组CR1率为89.65%,总有效率为96.55%,≥40岁组CR1率、总有效率均低于40岁组,比较具备统计学差别。依据贫血严重程度可以将所有患者分成轻度贫血组和中重度贫血组,首次化疗后轻度贫血组CR1率为100%,总有效率100%,中重度贫血组CR1率为62.50%,总有效率为78.12%,两组之间CR1率、总有效率分别比较,轻度贫血组都高于中重度贫血组,具备统计学差别。29例CD10+组患者首次化疗后CR1率为86.20%,总有效率为96.55%,21例CD10-组CR1率为61.90%,总有效率71.42%,CD10-组完全缓解率、总有效率都低于CD10+组,具备统计学差异。26例CD20+组患者首次化疗后CR1率为57.69%,总有效率为73.08%,24例CD20-组患者第一次化疗后完全缓解率为95.83%,总有效率100%,CD20-组的CR1率、总有效率都高于CD20+组,具备统计学意义。24例CD13+组患者首次化疗后CR1率为62.50%,总有效率为70.83%,26例CD13-组患者CR率为88.46%,总有效率100%,CD13+组完全缓解率、总有效率均低于CD13-组,统计学比较存在差异。11例CD33+组患者首次化疗后CR1率为45.45%,总有效率为54.54%,37例CD33-组患者CR1率为86.48%,总有效率94.59%,CD33+组完全缓解率、总有效率均低于CD33-组,统计学比较有差异。25例CD34+组患者首次化疗后CR1率为64.00%,总有效率为72.00%,20例CD34-组患者CR1率为95.00%,总有效率100%,CD34+组完全缓解率、总有效率均低于CD34-组,统计学比较有差异。15例CD96+组患者首次化疗后CR1率为46.66%,总有效率为60.00%,16例CD96-组患者CR1率为87.50%,总有效率93.75%,CD96-组的CR1率、总有效率均高于CD96+组,具备统计学差别。29例My+B-ALL组患者中有首次化疗后CR1率为65.51%,总有效率为75.86%,21例My-B-ALL组患者中首次化疗后CR1率为90.47%,总有效率100%,My-B-ALL组CR1率、总有效率两者都高于My+B-ALL组,统计学比较有差异。CD34/CD13抗原共表达组占总例数的20.00%,CD34/CD33共表达组占总例数的14.00%,CD34/CD96共表达组占总例数的18.00%。CD34/CD13抗原共表达组和非共表达组的CR1率分别是30.00%,86.20%,其总有效率分别是30.00%,100%。CD34/CD33抗原共表达组和非共表达组的CR1率分别是28.57%,77.27%,其总有效率分别是28.57%,90.90%。CD34/CD96抗原共表达组和非共表达组的CR1率分别是22.22%,86.36%,其总有效率分别是33.33%,95.45%。CD34/CD13抗原共表达组CR1率、总有效率均明显低于CD34/CD13非共表达组,具备显著统计学意义。CD34/CD33共表达组的CR1率、总有效率均低于CD34/CD33非共表达组,具备统计学意义。CD34/CD96共表达组的CR1率、总有效率均低于CD34/CD96非共表达组,具备统计学意义。结论:1.CD19是B-ALL的敏感性、特异性抗原;CD7、CD5可跨系表达于B-ALL;B-ALL伴髓系抗原中CD13阳性率最高。2.性别对B-ALL临床疗效无影响;年龄是影响B-ALL临床疗效的因素;初诊时贫血严重程度是影响B-ALL临床疗效的因素。3.CD10+与B-ALL临床疗效呈正相关,免疫表型CD20+、CD13+、CD33+、CD34+、CD96+均与B-ALL临床疗效呈负相关。4.My+B-ALL临床疗效差;抗原CD34/CD13、CD34/CD33、CD34/CD96共表达与B-ALL临床疗效呈负相关。
[Abstract]:Objective: To investigate the immunophenotypic characteristics and clinical significance of acute B-lymphoblastic leukemia (B-ALL). Methods: Immunophenotyping of 50 newly diagnosed patients with BCR-ABL fusion gene negative acute B-lymphoblastic leukemia was performed by flow cytometry (FMC). Results: The expression rate of CD19+ in B cell antigen was 84.00% and the positive rate was the highest. T cell antigen CD5 and CD7 could be expressed across lines. The expression rate of CD13+ in myeloid antigen was the highest (48.00%). After the first chemotherapy, the CR1 rate was 77.27%, the total effective rate was 95.45%, the female CR1 rate and the total effective rate were 75.00% and 78.57%, respectively. According to the severity of anemia, all patients can be divided into mild anemia group and moderate and severe anemia group. After the first chemotherapy, the CR1 rate of mild anemia group is 100%, the total effective rate is 100%, and the CR1 rate of moderate and severe anemia group is 62.50%. The total effective rate was 96.55%. The CR1 rate was 61.90%. The total effective rate was 71.42%. The total effective rate of CD10-group was lower than that of CD10+group. The total effective rate was 73.08%. The total effective rate was 95.83%. The total effective rate was 100%. The total effective rate was higher in the CD20 group than that in the CD20 + group. The total effective rate was 62.50% in the CD13 + group. The total effective rate was 100%. The total effective rate of CD13 + group was lower than that of CD13 - group. The total effective rate was 45.45%. The total effective rate was 54.54%. The total effective rate was 86.48%. The total effective rate was 94.59%. The total effective rate of CD33 + group was lower than that of CD13 - group. The CR1 rate was 64.00%, the total effective rate was 72.00%, the CR1 rate was 95.00%, the total effective rate was 100%, the total effective rate was 100%, and the total effective rate was lower in the CD34 + group than in the CD34 - group. The CR1 rate in the CD96 + group was 46.6% after the first chemotherapy. The total effective rate was 60.00%. The total effective rate was 87.50% and 93.75% in 16 patients with CD96-group. The total effective rate of CD96-group was higher than that of CD96+group. The total effective rate was 65.51% and 75.86% in 29 patients with My+B-ALL after the first chemotherapy. The total effective rate was 90.47% and 1.47% in 21 patients with My-B-ALL after the first chemotherapy. The CR1 rate and total effective rate in my-B-ALL group and my-B-ALL group were higher than those in my+B-ALL group. The CR1 rate of CD34/CD13 antigen co-expression group accounted for 20.00%, CD34/CD33 co-expression group accounted for 14.00%, CD34/CD96 co-expression group accounted for 18.00% and CD34/CD96 co-expression group accounted for 30.00% and 86.20% respectively. The total effective rates were 30.00% and 100%, respectively. The CR1 rates of CD34/CD33 co-expression group and non-co-expression group were 28.57% and 77.27%, respectively. The total effective rates were 28.57% and 90.90% respectively. The CR1 rates of CD34/CD96 co-expression group and non-co-expression group were 22.22% and 86.36% respectively. The total effective rates were 33.33% and 95.45% respectively. The total effective rate of the CD34/CD33 co-expression group was lower than that of the CD34/CD13 non-co-expression group. The total effective rate of the CD34/CD33 co-expression group was lower than that of the CD34/CD33 non-co-expression group. The total effective rate of the CD34/CD96 co-expression group was lower than that of the CD34/CD96 non-co-expression group. CD7 and CD5 can be expressed in B-ALL; CD13 positive rate is the highest in B-ALL with myeloid antigen. 2. Gender has no effect on clinical efficacy of B-ALL; age is the factor affecting clinical efficacy of B-ALL; anemia severity is the factor affecting clinical efficacy of B-ALL at initial diagnosis. 3. CD10 + is positively correlated with clinical efficacy of B-ALL, and immunophenotype is the highest. CD20 +, CD13 +, CD33 +, CD34 +, CD96 + were negatively correlated with the clinical efficacy of B-ALL. 4. My + B-ALL had poor clinical efficacy; the co-expression of antigen CD34/CD13, CD34/CD33, CD34/CD96 was negatively correlated with the clinical efficacy of B-ALL.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71

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