192例急性髓系白血病免疫表型、细胞遗传学及临床特征的研究

本研究对192例急性髓系白血病（AML）患者进行免疫表型检测，并探讨其与细胞遗传学改变和临床特征的关系。应用流式细胞术及一组系列相关单克隆抗体对192例AML患者骨髓进行免疫表型分析，用染色体G显带技术对其中的125例进行核型分析。结果显示，髓系抗原CD13、CD33、MPO、CD117表达最常见于AML。CD117表达于84．6％AML—M3病例中；较强的自发荧光、CD34与HLA—DR双阴性、表达相关髓系抗原CD13、CD33和MPO对于AML—M3诊断具有一定参考价值。CD14仅在AML—M4和AML—M5中表达；CD64和CD15同时强阳性伴HLA—DR高表达提示AML—M5可能性大。192例AML中，有47．9％伴淋系抗原表达，其中以CD7（20．8％）和CD56（26．0％）最常见，其次为CD19（9．9％）和CD2（7．3％）。125例AML中核型异常者76例（60．8％）。17例伴t（8；21）的AML—M2患者CD19、CD56、CD15表达均明显增加。另外28例t（15；17）均见于M3；2例inv（16）见于M4E0。LymAg^＋组CD34阳性患者比例（77．2％）明显高于LymAg-组（48．0％）。结论：免疫表型对AML的诊断与分型至关重要，免疫表型与患者的异常核型改变及临床特征关系密切。本研究结果提示综合细胞形态学、遗传学及免疫表型分析，对AML患者诊断、分型及预后评估有重要意义。

Immunophenotypes, Cytogenetics and Clinical Features of 192 Patients with Acute Myeloid Leukemia

The objective of this study was to investigate the immunophenotypic subtype profiles of 192 patients with acute myeloid leukemia （AML） and its association to cytogenetics and clinical features. Immunophenotyping of 192 patients was performed by flow cytometry using a panel of monoclonal antibodies. The karyotypes in 125 out of 192 cases were anlyzed by G-banding technology. The results showed that CD33, CD13, myeloperoxidase （MPO） and CD117 were the most commonly expressed antigens in AML. CDll7 expressed in 84. 6% of AML-M3 cases. A combination of intensive autofluorescence, both CD34- and HLA-DR-, and high expression of CD13, CD33 and MPO had significant value for AML-M3 diagnosis. CD14 expressed only in AML-M4 and AML-Ms, and both intensive positivity of CD64 and CD15 with high expression of HLA-DR may suggest great possibility for diagnosis of AML-M5. Lymphoid marker expression was documented in 47.9% of the 192 AML cases. CD56 （26.0%） and CD7 （20.8%） were the most commonly expressed lymphoid markers in AML patients, followed by CD19 （9.9%） and CD2 （7.3%）. Abnormal karyotypes were detected in 76 out of 125 cases （60.8%）. Correlation test showed that t（8 ;21 ） was found only in 17 cases of AML-M2 and strongly associated with the individual or combinational expressions of CDI5/CD19/ CD56. And 28 cases of t （ 15 ;17 ） were found in AML-M3 ; 2 cases of inv （ 16 ） were found in AML-M4no. Higher CD34 positivity was found in LymAg ＋ group （77.2%） than that in LymAg- group （48. 0% ）. It is concluded that immunophenotype analysis is useful for AML diagnosis and classification, and the immunophenotype has close relevance to the abnormal cytogenetic changes and clinical features in AML. The results suggested that a new prognostic scoring system that integrated the morphology, cytogenetic abnormalities and immunophenotype parameters would benefit the diagnosis, classification, and estimation of prognosis in AML patients.