急性白血病形态学诊断及其发病特点——233例患者的10年回顾性分析  

Morphologic Diagnosis and Onset Characteristics of Acute Leukemia:A Retrospective Analysis of 233 Cases in 10 Years

作　　者：刘毅[1] 黄友章[1] 宫立众[1] 岑坚[1] 王立新[1] 向丹[1] 马巍娜[1] 唐湘凤[2] 吴南海[2] 龚小军[2] 王凯[2] 尹文杰[1] 赵德峰[1] 刘小鹏[1] 胡小山[1] 沈建良[1] 

机构地区：[1]海军总医院血液科,北京100048 [2]海军总医院儿科,北京100048

出　　处：《中国实验血液学杂志》2012年第4期823-828,共6页Journal of Experimental Hematology

摘　　要：本研究探讨急性白血病(AL)形态学诊断价值及AL发病特点。收集2001-2011年间本院初诊AL 233例患者骨髓和外周血细胞,进行形态学(M)、免疫学(I)、遗传学(C)和分子生物学(M)检查,比较形态学结论与MICM结论之间的关系,分析10年中AL的发病特点。结果显示:①形态学结论与MICM结论的符合率为84.3%,符合率依次是AUL与AML-M0<M1<HAL<M4<M2<M3<M5<ALL<M6、M7与AP;②形态学混淆,一类是AUL、M0、M1、ALL和HAL之间混淆,另一类是M2a、M3v、M4和M5之间混淆,形态学混淆者形态自身特点与MICM结论特点无规律可寻,准确诊断需依据MICM结论;③233例AL中,白血病细胞比例以M1最高而M2最低,前者中位值为92.5%,后者中位值则为49.5%;④男性患者多于女性患者,AML患者>ALL>HAL>AUL;在AML中,M2>M5>M4>M3>M1>M0>M6>M7>AP患者;⑤最小年龄1岁,最大88岁,中位发病年龄(岁):AUL为41.5,M0为40.8,M1为43.4,M2为46.3,M3为33.8,M4为42.6,M5为48.8,M6为77.3,M7为2.5,AP为65.0,ALL为29.1,HAL为40.3;⑥近5年患者数(139例)明显多于前5年(94例)患者数,特别是M1、M2、M3、M4和M5。结论:在AL的MICM诊断中,形态学诊断具有重要的临床价值,重视易混淆的白血病细胞形态及发病特点可提高诊断的准确性。The objective of this study was to evaluate the value of morphologic diagnosis for acute leukemia（ AL）, to explore the relation of morphologic diagnosis with immunology, cytogenetics and molecular biology diagnosis of AL and to analyze the onset characteristics of AL in 10 years. The samples of bone marrow and peripheral blood from 233 newly diagnosed cases of AL were collected during 2001 -2011 years; the morphologic examination and immunologic, cytogenetic and molecular biologic examination（ICM） were carded out, the consistency of morphologic diagnosis with ICM diagnosis was compared, the onset characteristics of AL was analyzed. The results showed that： （1）the consistent rate of immunology, cytogenetics, molecular biology diagnosis with morphologie diagnosis was 84.3%. The order of consistent rat was AUL, M0 〈 M1 〈 HAL 〈 M4 〈 M2 〈 M3 〈 M5 〈 ALL 〈 M6, M7, AP; （2）Misdiagnosis always occurred among AUL,M0,M1 ,ALL and HAL or among M2a,M3v,M4 and M5. （3）In 233 cases, the highest ratio of blast was observed in M1 （92.5%）, while the lowest ratio of blast was observed in M2（49.5% ）. （4）AL occurred more frequently in males than that in female （147：86）. （5）AL occurred in patients aged from 1 to 88 years. The median age was 41.5 for AUL, 40.8 for M0, 43.4 for MI, 46.3 for M2, 33.8 for M3, 42.6 for M4, 48.8 for M5, 77.3 for M6,2.5 for M7,65.0 for AP, 29.1 for ALL and 40.3 for HAL. （6）The number of patients in the later five years （ 139 cases） was significantly greater than that in the first five years（94 cases）, especially the patients with M1, M2, M3, M4, and M5. It is concluded that morphologic diagnosis has important clinical value in the MICM diagnosis of AL. Attaching impor- tance to the confusing cell morphology and onset characteristics of AL can improve the diagnostic accuracy.

关 键 词：急性白血病 形态学 免疫学 细胞遗传学 分子生物学 

分 类 号：R733.71[医药卫生—肿瘤]