急性淋巴细胞白血病免疫表型与细胞遗传学及临床特征的关系

目的 探讨急性淋巴细胞白血病(ALL)患者免疫表型与细胞遗传学改变和临床特征的关系.方法 应用流式细胞术及相关单克隆抗体,Cell Quest软件获取并分析50 000个细胞,通过CD_(45)/侧向角散射光强度(SSC)设门识别幼稚细胞,对113例ALL患者骨髓进行免疫表型分析;采用骨髓细胞72 h培养法常规制备染色体,R显带技术对其中的74例进行核型分析.结果 113例ALL患者中,14.2%(16/113)为T淋巴细胞急性淋巴细胞白血病(T-ALL),85.8%(97/113)为B淋巴细胞急性淋巴细胞白血病(B-ALL).113例ALL患者中有106例进行髓系抗原检测,34.9%(37/106)ALL患者表达髓系抗原(MyAg),CD_(13)是ALL中最常见的MyAg(23.6%,25/106).T-ALL髓系相关抗原表达总的阳性率为46.2%(6/13),B-ALL为33.3%(31/93),差异无统计学意义(X~2=0.825,P＞0.05).成人ALL各髓系相关抗原表达总的阳性率为47.6%(20/42),高于儿童的26.6%(17/64),差异有统计学意义(X~2=4.948,P＜0.05).可供核型分析的74例ALL中,核型异常者39例(52.7%).MyAg~+ALL与MyAg~-ALL患者临床和生物学特征分析表明,MyAg~+组高白细胞(＞50×10~9/L)患者比例为48.6%(18/37),高于MyAg-ALL组的20.3%(14/69),差异有统计学意义(X~2=9.191,P＜0.01);MyAg~+ALL组CD_(34)阳性患者比例为83.8%(31/37),高于MyAg~-ALL组的53.6%(37169),差异有统计学意义(X~2=9.527,P＜0.05);而且MyAg~+ALL组成人患者比例(54.1%,20/37)高于MyAg~-ALL组(31.9%,22/69),差异有统计学意义(X~2=4.948,P＜0.05).结论 ALL免疫表型与细胞遗传学改变和临床特征具有一定相关性,将免疫表型与细胞遗传学检测相结合,有助于ALL诊断.

Study of immunophenotype of acute lymphoblastic leukemia and its correlations to cytogenetics and clinical features

objective To investigate the immunophenotype of Chinese patients with acute lymphoblastic leukemia(ALL)and its association to cytogenetics and clinical features.Methods In this study.a total of 113 Chinese patients with ALL were immunophenotyped by flow cytometry using a panel of monoclonal antibodies.50 000 cells were acquired and analyzed with Cell Quest and abnormal populations were recognized by CD_(45)/SSC gating.Among the 113 patients enrolled in this study,bone marrow cells of 74 patients were cultured for 72 hours to prepare for conventional chromosome detection.and karyotype was analyzed with R-banding technique.Results Of 113 ALL patients,14.2%(16/113)were identified as TALL,85.8%(97/113)as B-ALL Among the 106 out of 113 ALL cases,myeloid antigen(MyAg)expression was documented in 34.9%(37/106)and CD_(13) was the most commonly expressed MyAg in ALL patients(23.6%,25/106).MyAgs were more frequently associated with T-ALL(46.2%,6/13)than with B-ALL(33.3%,31/93)but there was no significant difieFence(X~2=0.825,P＞0.05)between the two groups.MyAg positivity in adult ALL patients(47.6%,20/42)was higher than that in children(26.6%,17/64).There was a significant difference between the two groups(X~2=4.948,P＜0.05).Abnormal karyotypes were detected in 39 out of 74(52.7%)patients.It showed that percentage of patients with high WBC count(＞50×10~9/L)in MyAg~+(48.6%,18/37)was higher than that in MyAg~-ALL types (20.3%,14/69).There was a significant difference between the two groups(X~2=9.191,P＜0.01).CD34 expression was found in 83.8%(31/37)of MyAg~+ and 53.6%(37/69)of MyAg~-cages.There was a significant difference between the two groups(X~2=9.527,P＜0.05).In addition,the percentage of adult ALL patients in MyAg~+ group(54.1%,20/37)was higher than that in MyAg~-group(31.9%,22/69).There was a significant difference between the two groups(X~2=4.948,P＜0.05).Conclusion lmmunophenotype analysis is useful for ALL diagnosis and classification and the immunophenotype has relevance to the abnormal cytogenetic changes and clinical features in ALL patients.