MICM分型在急性早幼粒细胞白血病诊断中的应用

目的 探讨MICM分型在急性早幼粒细胞白血病（APL,M3）诊断中的价值.方法 形态学采用Wright染色,细胞化学过氧化物酶（POX）、糖原染色（PAS）、非特异性酯酶加氟化钠抑制试验（NSE＋NaF）、特异性酯酶（CE）染色按常规方法;应用免疫酶标记技术和流式细胞术进行免疫学分型;用24 h短期培养法G带方法进行染色核型分析;用RT-PCR检测PML/RARa融合基因.结果 61例APL中粗颗粒型17例、细颗粒型12例、混合颗粒型30例、变异型2例,POX、NSE、NSE＋NaF、PAS、CE阳性率分别为99.7%、82.4%、71%、97%、99.6%;33例免疫学分型：CD13 90.8%、CD14 91.8%、CD33 96.6%、CD68 86%、MPO 96.6%、HLA-DR 28.7%、CD19 15%、CD10 12%、CD3不表达;31例染色体分析中21例具有t（15;17）,其中1例还具有额外累及17号染色体异常,6例正常核型,4例培养无分裂象;24例APL中17例PML/RARa融合基因转录本阳性,4例阴性,3例失败.结论 MICM分型使APL的诊断更准确,便于临床更好地选择治疗方案和判断预后.

The application of MICM classification in diagnosis of acute promyelocytic leukemia

Objective To explore the value of MICM classification in diagnosis of acute promyelocytic leukemia（APE）. Methods the diagnosis of acute promyelocytic leukemia： morphology and chemical staining were tested under microscope, immunological classification wre examinated immunohistochemistry, cytogenetics was used by Giema-binding chromosome, PML/RARa fusion gene was determined by RT-PCR. Results 61 APL cases including 17 cases of coarse morphology,12 cases of fine morphology,30 cases mixed particles, 2 case of variant morphology, positive rate of POX, NSE, NSE ＋ NaF, PAS, CE were 99.7 %, 82.4 %, 71 %, 97 %, 99.6 %, respectively, hnmunological classification of 33 cases ： positive rates of CD13, CD14, CD33, CD68, MPO, HLA-DR, CD19 ,CD10 ,CD3 were 90.8% ,91.8% ,96.6%,86.0% ,96.6% ,28.7% ,15.0% ,12.0% ,0.0% ,respectively. Chromosomal analy- sis of 31 cases： 21 cases were chromosomal translocation（15; 17）, 6 cases were normal caryotype, 4 cases were cultural failure. PML/RARa fusion gene were positive in 17 cases,4 cases were negative and 3 cases fail from all of detected 24 cases. Conclusion MICM classification is more accurate in diagnosis of acute promyelocytic leukemia, so that clinicians choose initial treatment regimen better and judge prognosis.