退化细胞ZAP-70在慢性淋巴细胞白血病的表达及预后影响  

Expression and Prognostic Significance of Smudge Cells or ZAP-70 in Chronic Lymphocytic Leukemia

作　　者：郑正津[1] 宋清晓[1] 王少元[1] 黄慧芳[1] 

机构地区：[1]福建省血液病研究所、福建医科大学附属协和医院血液科,福州市350001

出　　处：《中国肿瘤临床》2012年第20期1527-1529,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨退化细胞、ZAP-70在慢性淋巴细胞白血病(CLL)患者外周血中的表达及其对预后的影响。方法:利用光学显微镜观察退化细胞在92例CLL患者外周血涂片的检出率;采用流式细胞术检测外周血淋巴细胞XAP-70的阳性率。分析二者之间的相关性,并观察这二项指标与疾病进展的关系。结果:在92例CLL患者中,Binet A期28例(30.5%),Binet B期44例(47.8%),Binet C期20例(21.7%)。外周血涂片退化细胞百分比的中位数为19%(3%～48%)。取≥20%为阳性表达,则退化细胞阳性56例(60.9%);ZAP-70阳性32例(34.8%)。双因素直线相关分析提示二者呈负相关。退化细胞阴性患者临床预后差,较阳性患者的8年无进展生存率(PFS)下降(59.4%vs.86.0%,P<0.05),ZAP-70阳性患者较阴性患者的8年PFS也下降(57.8%vs.79.5%,P<0.05);退化细胞阴性伴ZAP-70阳性患者PFS更低(27.8%,P<0.05)。结论:退化细胞阴性和ZAP-70阳性提示CLL预后不良且二者密切相关。Objective： To study the expression and prognostic significance of the percentage of smudge cells or ZAP-70 in chronic lymphocytic leukemia （CLL）. Methods： The percentage of smudge cells was observed on routine blood smears in a cohort of 92 CLL patients. ZAP-70 expression was determined by flow cytometry. The relationship of CLL progression with the smudge cells or ZAP-70 was analyzed. Results： Among the 92 patients, 28 （ 30.5% ） were Binet A, 44 （ 47.8% ） were Binet B, and 20 （ 21.7% ） were Binet C. The percentage of smudge cells ranged from 3% to 48% （ median=19% ）. When the eutoffvalue was 20 %, 56 （ 60.9% ） of the cases were positive for smudge cells, and 32 （ 34.8% ） were positive for ZAP-70. A high ZAP-70 expression was found to be correlated with a low percentage of smudge cells. Patients with 〈 20% smudge cells （ according to ROC analysis ） were characterized by an unfavorable clinical course, i.e., significantly shorter progress-free survival, than those with ≥ 20% smudge cells （ 59.4% vs. 86%, P〈0.05 ）. Patients with positive ZAP-70 expression had a significantly shorter progress-free survival than those with negative ZAP-70 expression （ 57.8% vs. 79.5%, ,P〈0.05 ）. Combined analysis revealed a shorter progress-free survival in patients with 〈 20% smudge cells and positive ZAP-70 expression （ 27.8%, P〈0.05 ） than in those with 〈 20% smudge cells and negative ZAP-70 expression. Conclusion： There is a close correlation between a smudge cell-negative status and positive ZAP-70 expression, which predicts unfavorable CLL prognosis.

关 键 词：慢性淋巴细胞白血病 退化细胞 ZAP-70 预后 

分 类 号：R733.72[医药卫生—肿瘤]