流式细胞术免疫分型诊断急性早幼粒细胞白血病的临床意义

急性早幼粒细胞白血病（APL）是高死亡率、高风险的恶性血液肿瘤，尽管以联合使用全反式维甲酸（ATRA）和三氧化二砷（ATO）为主的治疗方法问世后，其生存率显著提高,但治疗中仍存在许多并发症，并发生早期死亡。所以尽早对APL进行诊断治疗并对预后作出判断尤为重要。随着流式技术的展开，流式免疫表型在APL诊断中已被广泛应用。本篇文章通过对既往文献研究分析，发现CD33+CD13+MPO+CD34-HLA-DR-CD11b-这种免疫表型模式对于诊断APL具有一定意义。CD34表达较少，但与白细胞增多症、bcr3同种型、M3v以及CD2的表达相关，可作为判断高风险APL的一个依据。CD2与CD34共表达的患者具有较高的早期死亡率以及较低的完全缓率，但对于CD2单独表达的相关研究较少，还不能定论。CD56与CD34、HLA-DR、CD15、CD117、T细胞相关抗原的表达以及bcr3-PML/RARα 具有相关性，存在较低的完全缓解率以及较高的中枢神经系统白血病复发率，并且在多变量分析中被认为是唯一与复发相关的预后因素，且与预后的关系独立于高白细胞计数。虽有文献报道CD123、CD117可作为预判APL预后的参考，但被认为证据上不充足，有待进一步考究。

Clinical significance of flow cytometry immunophenotyping for the diagnosis of APL

Acute promyelocytic leukemia (APL) is a high-mortality,high-risk malignant hematologic tumor.Although the treatment with a combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) was introduced,the survival rate was significantly improved.However,there are still many complications in the treatment and early death.With the development of flow technique,flow immunophenotyping has been used in the diagnosis of APL.It is widely used.Through the analysis of previous literature,it is found that the immunophenotyping model of CD33+CD13+MPO+CD34-HLA-DR-CD11b- has certain significance for the diagnosis of APL.The expression of CD34 is less,but it is related to leukocytosis,bcr3 cotype,M3v and CD2 expression,which can be used as a basis for judging high risk APL.Patients with co-expression of CD2 and CD34 have high early mortality and low CR rate.However,there are few studies on the expression of CD2 alone,which can not be determined.CD56 is associated with CD34,HLA-DR,CD15,CD117,T cell-associated antigen expression and bcr3-PML/RARα,with lower CR rate and higher recurrence rate of central nervous system leukemia,and in multivariate analysis，CD56 was considered to be the only prognostic factor associated with relapse,and the relationship with prognosis was independent of high white blood cell counts.Although there are reports in the literature that CD123 and CD117 can be used as a reference for predicting the prognosis of APL,it is considered to be insufficient in evidence and needs further study.