伴髓系抗原表达的急性淋巴细胞白血病MIC分型特征分析  

MIC categorization of acute lymphoblastic leukemia with myeloid surface antigen expression

作　　者：吴伟林[1] 梁建英[1] 朱明清[1] 薛永权[1] 陈子兴[1] 

机构地区：[1]苏州大学附属第一医院,江苏省血液研究所215006

出　　处：《中华血液学杂志》2007年第11期754-756,共3页Chinese Journal of Hematology

摘　　要：目的探讨伴髓系抗原(My)表达的急性淋巴细胞白血病(My^+ALL)MIC 分型特征。方法按常规骨髓涂片及过氧化物酶染色法对120例初治 ALL 患者进行形态学分型,采用流式细胞术检测白血病细胞免疫学类型,用 R 显带技术分析染色体核型,对 My^+ALL 及 My^-ALL 患者 MIC 分型进行分析比较。结果 120例初治 ALL 患者中 My^+ALL 66例(55%),其中 My^+B-ALL 50例,占 B～ALL 的56.8%;My^+T-ALL 14例,占 T-ALL 的50%;My^+T、B-ALL 2例,占 T、B-ALL 的50%。66例My^+ALL 患者形态学分型有10例(15.1%)误诊为急性非淋巴细胞白血病(ANLL);54例 My^-ALL 无一例误诊为 ANLL。My^+ALL 患者形态学分型与免疫分型不符率或形态学分型不明确病例明显高于My^-ALL(P<0.01)。My^+ALL 患者95.5%表达 CD13,81.8%表达 CD33,77.3%同时表达 CD13及CD33,1.5%表达 CO117。CD14、CD15及 MPO 表达阴性。My^+ALL 患者 CD34阳性表达率明显高于My^-ALL(P<0.01)。My^+ALL 及 My^-ALL 患者异常染色体核型的检出率分别为72.3%和66.7%(P>0.05),My^+B-ALL 患者的 t(9;22)或 t(9;22)伴其他染色体核型异常的检出率显著高于 My^-B-ALL(P<0.01)。My^+T-ALL 及 My^-T-ALL 患者末见 t(9;22)异常。My^+ALL 和 My^-ALL 患者 CR 率分别为83.9%和79.0%,差异无统计学意义(P>0.05)。结论 My^+ALL MIC 分型部分细胞形态学可显示有髓系细胞特征,易被误诊为急性髓系白血病。My^+ALL 患者 CD34表达率明显高于 My^-ALL。My^+B-ALL 的 t(9;22)异常显著高于 My^-B-ALL。My^+ALL 与 My^-ALL 缓解率差异无统计学意义。Objective To explore the characteristics of morphology, immunophenotype and cytoge- netics（MIC） of myeloid surface antigen-expressing acute lymphoblastic leukemia （ My^＋ ALL）. Methods One hundred and twenty untreated acute lymphoblastic leukemia （ALL） patients were diagnosed by standard bone marrow smear morphologic analysis and peroxydase staining. Flow cytometry and myeloid monoclonal an- tibodies（McAb） were used to analyze immunophenotype. Chromosome karyotypes were analyzed by R-band technique. Results Of 120 cases, 66 （55%） were My^＋ ALL, including 50 cases of My^＋ B-ALL（56.8% of B-ALL ）, 14 cases of My^＋T-ALL（50% of T-ALL） and 2 cases of My^＋ T and B-ALL（50% of T and B- ALL）. Of 66 My^＋ ALL, 10 cases （15. 1%） were misdiagnosed as acute non-lymphobastic leukemia （ ANLL）, the other 54 My^- ALL cases were correctly diagnosed. The inconsistent rate between morphological and immunophenotype classifications was higher in My^＋ ALL than in My^- ALL , and there were more atypical morphology cases in My^＋ ALL than in My^- ALL（P〈0.01）. In My^＋ ALL cases 95.5% expressed CD13, 81.8% CD33, 77.3% CD13 and CD33 simultaneouly, and 1.5% CDll7, but none CD14, CD15 and MPO. CD34 expression rate in My^＋ ALL cases was significantly higher than that in My^- ALL（P〈0. O1 ）. Cytogenetic abnormalities rates in My^＋ ALL and My^- ALL were 72.3% and 66.7% （ P 〉 0.05 ） respectively. t （9 ;22 ） and t （9 ;22 ） plus other cytogenetic abnormalities were detected more frequently in My^＋ B-ALL cases than in My- B-ALL （ P 〈 0.01 ）, and not in My^＋ T-ALL and My- T-ALL cases. The complete remission （CR） rates was 83. 9% inMy^＋ ALLand79% inMy- ALL（P〉0.05）. Conclusion My＊ ALLhadaspe- cific characteristics in morphology, immunophenotype and cytogenetics. Some cases have a myeloid morpho- logic appearance and might be misdiagnosed as acute myeloid leukemia （AML）. My^＋ ALL have a higher CD34 expression rate than My^- ALL. t （9;22）

关 键 词：白血病 淋巴细胞 急性 伴髓系抗原表达 MIC分型 

分 类 号：R733.7[医药卫生—肿瘤]