急性髓系白血病患者131例免疫表型与预后的相关性分析

目的 探讨急性髓系白血病(AML)免疫表型与预后的相关性.方法 采用多色流式细胞术对131例AML患者进行检测,分析其免疫表型与患者年龄、初诊时WBC、PLT和Hb的关系,及其对完全缓解率(CR)的影响.结果 AML患者中髓系抗原表达阳性率最高的是CD13、CD33和髓过氧化物酶(MPO),急性早幼粒细胞白血病(M3)亚型中CD34和HLA-DR表达率较低,淋巴细胞抗原CD19和CD7表达最常见,阳性率分别为15.4%和14.6%.CD7阳性组患者的年龄明显高于阴性组患者年龄(t=-2.27,P＜0.05),CD14阳性组患者的初诊WBC计数明显高于阴性组(Z=-2.284,P＜0.05).131例AML患者的总CR率为56.5%,CD34阳性组(82例)的CR率为45.1%,CD34阴性组(49例)的CR率为75.6%,两组间差异有统计学意义(x2=11.524,P＜0.05).CD34和HLA-DR双阳性组(74例)的CR率为41.9%,单阳性组(38例)CR率为78.9%,双阴性组(19例)CR率为68.4%,3组问差异有统计学意义(Z=-3.492,P＜0.01).CD7、CD19、CD13、CD33、CD38、CD15、CD64、CD14及MPO等抗原表达阳性组和阴性组间CR率的差异无统计学意义(P均＞0.05).多因素回归分析显示,患者年龄大于60岁、初诊时WBC大于50×109/L、PLT大于30×109/L、Hb小于60 g/L以及CD34阳性是低CR率的独立风险因素.结论 AML患者年龄,初诊时WBC、PLT和Hb计数以及CD34表达与CR率有关,免疫表型的检测对于判断AML预后有一定价值,有助于指导临床治疗和判断预后.

Prognostic relevance of immunophenotyping in 131 patients with acute myeloid leukemia

Objective To investigate the correlation of prognosis with the immunophenotype in acute myeloid leukemia(AML)patients.Methods Immunophenotyping was performed in 131 patients with AML by mtdtieolor flow cytometry.Correlation of immunophenotype with other laboratory parameters such as initial white blood cell count(WBC),platelet count(PLT),hemoglobin(Hb),and the complete remission(CR)ratio was analyzed.Results In these AML patients,myeloid antigens CDl3,CD33 and myeloperoxidase(MPO)were more highly expressed than other antigens.Expression of CD34 and HLA-DR were lower in acute promyelocytic leukemia(M3)subtype.The expression of lymphocyte antigen CD19 and CD7 were the highest.CD7 expression was associated with age(t=-2.27,P＜0.05).CD14 was associated with initial WBC(Z=-2.284,P＜0.05).The overall CR ratio was 56.5%among all patients.CD34positive patients had a significantly lower CR rato(45.1%),compared with the CD34 negative patients whose CR ratio was 75.6%(x2=11.524,P=0.001).The CR ratio was significantly lower in cases expressing both CD34 and HLA-DR(74 patients with CR rate 41.9%)than in cases expressing only CD34 or HLA-DR(38 patients with CR rate 78.9%)and both negative(19 patients with CR rate 68.4%)(Z=-3.492,P＜0.01).However,other antigens,including CD7,CD19,CD13,CD33,CD38,CD15,CD64,CD14 and MPO had no significant association with CR ratio.Logistic regression analysis showed that age(60 years or older),initial WBC(more than 50 x 109/L),PLT(more than 30 x 109/L),Hb(less than 60g/L)and CD34 were independent adverse factors for achieving CR.Conclusions In AML patients,age,initial WBC,PLT,Hb and CD34 are associated with CR ratio.Detection of immunophenotype may help to estimate prognosis of patients with AML and guide the treatment of AML.