微分化急性髓系白血病病人MICM特征分析(附1例报告)  

Analysis of MICM characteristics of minimally differentiated acute myeloid leukemia-a case reported

作　　者：翟洪顺 邹德学 聂李平 刘延涛 周宇 

机构地区：北京大学深圳医院血液实验室,广东,深圳,518036 北京大学深圳医院血液实验室,广东,深圳,518036 北京大学深圳医院血液实验室,广东,深圳,518036 深圳阳光医院检验科,广东,深圳,518008 北京大学深圳医院血液实验室,广东,深圳,518036

出　　处：《现代医学仪器与应用》2008年第2期4-10,共7页

摘　　要：目的 探讨微分化急性髓系白血病AML-M0 MICM特征并与其他类型白血病鉴别.方法 常规细胞染色,流式分析,染色体核型,FISH及分子生物学方法.结果 用MPO mRNA进行基因分型是一种新的更加敏感、特异的白血病诊断分型手段.原始细胞免疫表型对诊断M0有重要意义;M0的原始细胞形态学特点不明显,其过氧化物酶(POX)、苏丹黑(SBB)、特异性酯酶(CE)染色均为阴性,而酸性非特异性酯酶(ANAE),酸性磷酸酶(ACP)及糖原(PAS)染色呈阴性或弱阳性,ANAE酶型与M1、急性淋巴细胞白血病(ALL)相似,表现为局灶型且不被氟化钠(NaF)抑制,PAS酶型为细颗粒弥散状分布,在此基础上夹有珠状、块状,而ALL酶型为细颗粒、中粗颗粒和粗颗粒散在分布.部分细胞可见珠状、块状且背景较清晰干净.结论 ANAE、PAS在细胞化学染色中对AML-M0的诊断有很重要的参考价值.将基因分型,免疫分型,与细胞形态学、遗传学四者相结合,能极大地提高AML-M0的诊断率.Objective To discuss the MICM characterisics of minimally differentiated acute myeloid leukemia and distinguish from other types of leukemia.Methods Routine morphology,cytochemistry staining,immunophenotyping,cytogenetics,and molecular methods and MPO mRNA expression were performed.Results MPO mRNA expression and Immunophenotype are specific and sensitive for early diagnosis of AML-M0.They facilitate diagnosis rate.Cytochemical staining for POX,SBB,CE were negative in myeloblast from M0 patients,while Cytochemical staining for periodic acid-Schiff,ACP and NSE negative or weakly positive.Similar to AML-M1 and ALL,AE enzyme in M0 was focal type and could not be inhibited by NaF.PAS enzyme in M0 was fine granular and mainly diffused but with few beads or clumps.Otherwise PAS enzyme in ALL was diffused fine granular,medium size granular and coarse granular,bead type or clumps type only could be detected in few cells and the background was clear and clean.Conclusion ANAE,PAS staining is important and MPO messenger RNA(MPO mRNA) appears to be the most sensitive marker of myeloid differentiation,as it can be detected in early myeloid precursors and their leukemic counterparts prior to MPO protein expression.They faciliate diagnosis rate while combined with cytomophology and immunophenootype.

关 键 词：白血病 微分化 MICM 遗传分型 免疫分型 

分 类 号：R197.3[医药卫生—卫生事业管理]