老年急性髓系白血病的巨核系病态造血及免疫表型特征  

Megakaryocytic Dysplasia and Leukemia Associated Phenotype in Elderly Patients with Acute Myeloid Leukemia

作　　者：秦继霞[1] 徐娟[1] 孙雪静[1] 刘聪艳[1] 万岁桂[1] 惠吴函[1] 庄光艳[1] 赵弘[1] 

机构地区：[1]首都医科大学宣武医院血液科,北京100053

出　　处：《中国实验血液学杂志》2008年第5期1107-1110,共4页Journal of Experimental Hematology

摘　　要：本研究探讨老年急性髓系白血病(AML)骨髓巨核系病态造血和白血病相关表型特征。在显微镜下分析147例初发非M3-AML患者骨髓巨核系病态造血,应用流式细胞术分析白血病细胞跨系列及跨阶段表达特征,结合外周血白细胞数、染色体核型及诱导完全缓解率等因素,用Logistic回归方法分析年龄≥60岁的老年AML与中青年患者的不同。结果表明:在147例患者中124例患者完成了标准方案治疗,其中70例达到完全缓解,包括老年组18例和对照组52例,经统计学处理p=0.008;并且共有32例(21.8%)存在巨核系病态造血;CD33与CD19/CD7共表达(跨系列表达)者55例(37.4%),CD34与CD11b共表达(跨阶段表达)者65例(44.2%);发病时外周血白细胞数>25×109/L的患者52例(35.4%)。经Logistic回归分析显示,老年患者与中青年患者在巨核系病态造血、CD34与CD11b共表达及CD33与CD7/CD19共表达方面具有统计学意义的差异(OR=4.315,2.761,0.397;p=0.001,0.006,0.020),而染色体核型及发病时外周血白细胞总数无统计学意义差异(OR=0.802,1.096;p=0.646,0.813)。结论:老年患者巨核系病态造血、抗原跨阶段表达和抗原跨系列表达情况明显多于中青年组。This study was purposed to investigate the megakaryocytic dysplasia and leukemia-associated phenotypes （LAP） of acute myeloid leukemia （AML） in the elderly. The megakaryocytic dysplasia, lineage infidelity, asynchronous antigen expression, total WBC count, and karyotypes were observed in the 147 none M3-AML patients. Logistic regression were used to analyzed the differrence between the elderly （age≥60） and the control. The results showed that out of the total 147 patients （66 elderly patients, and 81 younger patients） 124 patients accepted induction chemotherapy, in which 70 cases achieved complete remission （ elderly 18, younger 52, p = 0.008 ） ; megakaryocytic dysplasia was found in 32 patients （21. 8% ）; CD33 and CD19/CD7 （lineage infidelity ） was co-expressed in 55 patients （37.4%）, CD34 and CD1 1b （asynchronous antigen expression） was co-expressed in 65 patients （44.2%）; white blood cell count 〉 25 × 10^9/L was found in 52 patients （35.4%）. By the Logistic regression, compared with the control, in the elderly patients there was difference in the megakaryocytic dysplasia, and the co-expression of CD33/CD19/ CD7 and CD34/CDllb （OR =4.315, 2.761, 0. 397; p =0,001, 0.006, 0.020）, but there was no difference in the total WBC count and karyotypes （OR = 0. 802, 1. 096;p = 0. 646,0. 813）. It is concluded that the incidence of megakaryocytic dysplasia, such as lineage infidelity, and asynchronous antigen expression, in elderly patients is higher than that in younger patients.

关 键 词：白血病相关表型 病态造血 老年白血病 

分 类 号：R733.71[医药卫生—肿瘤]