急性白血病免疫分型与临床研究

目的了解儿童急性白血病(AL)免疫表型的分布情况和抗原表达规律,并与临床特征及预后相结合,为临床个体化用药提供指导。方法对85例新近诊断为AL患儿,采用CD45/SSC双参数散点设门方法进行三色流式细胞术免疫表型分析。其中胞膜抗原采用单克隆抗体三色直接免疫荧光标记法,胞浆内抗原采用双色直标法。结果1.AL 85例免疫分型:未分化型(AUL)1例,占1.2%;杂合型7例,占8.2%;急性髓性白血病(AML)18例,占21.2%;急性淋巴细胞白血病(ALL)59例,占69.4%。其中B-ALL 50例,占84.7%;T-ALL 6例,占10.2%;T/B-ALL 3例,占5.1%。2.ALL 59例中髓系抗原表达31例,占52.5%。髓系抗原表达阳性组和阴性组临床特征、治疗反应及预后方面无明显差异。3.AML患儿中有淋系抗原表达5例,占27.8%,低于ALL有髓系表达。其中以CD7阳性率最高,为60%;CD14在M4、M5表达率为75%;CD13、CD33在AM中表达率分别为83.3%、94.4%。4.混合型白血病7例。其中B/M 6例,TB/M 1例;2例在FAB分型中疑为混合型,余5例为ALL。结论应用多色流式细胞术可较好地分析每例白血病患儿,尤其是对于混合型白血病及抗原交叉表达者更有意义。

Study on Clinical and Immunophenotype of Acute Leukemia in Children

Objective To study the clinical significance and characteristic of acute leukemia(AL) immunophenotype expression in children.Methods Immunofluoscence labeled with three and two color monoclonal antibodies directly were used to analyze the surface antigen and cytoplastic antigen.Cytoplastic antigen was detected by flow cytometry additionally.Results Specimens from 85 patients with childhood acute leukemia were detected.1.The undifferentiated phenotype account for 1 case(1.2%);Mixed leukemia 7 cases(8.2%);Acute myeloid leukemia 18 cases(21.2%);Acute lymphoid leukemia 59 cases(69.4%).The subtypes of acute lymphoid leukemia:(B-ALL) 50 cases(84.7%),T-ALL 6 cases(10.2%),T/B 3 cases(5.1%).2.Among 59 cases of acute lymphoid leukemia,there were 31 cases ALL expression myeloid-associated antigen;There was no difference on the clinical and prognosis between the group of myeloid-associated antigen positive and the negative group.3.Of 18 patients with AML,5 patients(27.8%) expressed lymphoid antigen,CD7 was the most commonly expressed(60%);The frequency of CD_(14) expression in childhood M4,M5 was 75%.CD_(13),CD_(33) presented in 83.3% and 94.4% cases of AML,respectively.4.Among 7 cases acute mixed leukemia,B/M 6 cases,TB/M 1 case.Five cases were misdiagnosed as ALL by FAB classification.Conclusions With the multi-color flow cytometry,every acute leukemia patient was diagnosed accurately,especially on acute mixed leukemia and cross-lineage expression leukemia.Those help us choice the best treatment protocol for childhood AL.