多参数流式细胞术鉴别诊断单核细胞相关性白血病的意义

目的：用多参数流式细胞术（FCM）鉴别诊断单核细胞相关性白血病（MLIL）。方法：采用CD45／SSC散点图设门多参数流式细胞术分析179例白血病细胞CD14及其它相关抗原的表达情况。结果：CD14在179例白血病中的表达，AML25．6％（30／117），CML5．9％（1／17）。CMML100％（3／3）；ALL、CLL、AUL、BAL CD14都阴性。117例AML中，AML-M4 CD14阳性占75．0％（15／20），AML-M5a 22．2％（2／9），AML-M5b 92．9％（13／14）。CD14在AML-M4／M5的阳性率无明显差异（P=0．486），而AML-M5a／M5b中有显著性差异（P〈0．001）。AML-M0、M1、M2、M6、M7中CD14全部阴性。在AML组中CD14的表达与CD117、CD34呈负相关。与CD64、HLA-DR、CD4、CD36、CD15、CD11b呈正相关。在CD45／SSC、CD71／CD33、CD15／CD11b散点图中M4／M5的粒细胞和单核细胞克隆位点明显不同。结论：CD14对单核细胞相关性白血病具有高特异性，敏感性不足；联合其它抗体不但可以区别单核细胞相关性白血病，而且可以鉴别AML-M4／M5亚型；CD45／SSC、CD71／CD33、CD15／CD11b三幅散点图有助于鉴别粒细胞和单核细胞克隆。

The significance of differential diagnosis of monocyte lineage involved leukemia by multi-parameter flow cytometry

Objective:To differential diagnose monocyte lineage involved leukemia(MLIL) by multi-parameter flow cytometry.Methods:The expression of CD14 and other related antigens were analyzed in 179 prime patients with leukemia by CD45/SSC Dot plot gated multi-parameter flow cytometry.Results:Among 179 patients with leukemia, the expression rate of CD14 were 25.6% in acute myelocytic leukemia(AML) , 5.9% in chronic myelocytic leukemia(CML) and 100% in chronic myelomonocytic leukemia(CMML) respectively, while it was negative expression in acute lymphoblastic leukemia(ALL), chronic lymphoblastic leukemia(CLL),acute undifferentiated leukemia(AUL) and acute bipolar phenotype leukemia(BAL) .With 117 AML patients, the positive rate of CD14 were 75.0% in M4(15/20), 22.2% in M5a(2/9) and 92.9% in M5b(13/14) respectively, it was no significant difference between M4 and M5(P=0.486), but it was significant difference between M5a and M5b(P<0.001); it was all negative in M0,M1,M2 ,M6 and M7 patients. In AML group, the expression of CD14 was negative correlation with CD117 and CD34,it was positive correlation with CD64,HLA-DR,CD4,CD36,CD15 and CD11b. Within the CD45/SSC,CD71/CD33 and CD15/CD11b scatter diagram, the clone site of granulocyte and monocyte were obviously different between M4 and M5.Conclusion:CD14 was high specificity and low sensitivity in diagnosing MLIL; CD14 association with other antigens could be used to distinguish not only MLIL but also M4 and M5 subtype; CD45/SSC,CD71/CD33 and CD15/CD11b Dot plot contributed to distinguish granulocyte and monocyte clone.