流式细胞术-白血病免疫分型规范化  

Flowcytometric-Immunophenotyping for Leukemia Needs to Be Standar-dized

作　　者：陈珊珊[1] 

机构地区：[1]北京大学人民医院,血液病研究所北京100044

出　　处：《中国实验血液学杂志》2002年第1期1-5,共5页Journal of Experimental Hematology

摘　　要：近十年来流式细胞术已被我国各级医院较广泛采用 ,主要用途之一是测定血液恶性肿瘤的免疫表型。流式细胞术的免疫分型 (FCM IM )可为白血病与淋巴细胞增殖性疾病 (LPD)提供准确的数据。国际上公认是诊断血液系统恶性疾病一项不可缺少的标准 ,还可提供指导治疗的相关信息。图 1与图 2示某些白血病与LPDs典型的免疫表型。值得注意的是变异是常见的。现提出以下几点注意事项以使实验结果更为可靠并减少实验室间的差异 :①用直接免疫标记法及多色分析法。②CD4 5 /SSC设门法优于FSC/SSC设门法 ,可更清楚地显示不正常细胞群体。在原 /幼细胞少时尤为明显。③结论中详细描述不正常细胞群的表型较计算各标志细胞的百分数更为重要。④用直接标记 ,多色分析法时不再以 2 0 %为正常值界线。⑤由于抗体 /抗原的多向性 ,白血病细胞抗原表达的不保真性以及白血病细胞生物学的多变性 ,单纯依靠FCM术数据勿轻易诊断杂合性或双表型白血病。流式细胞仪不是细胞计数器 。Flowcytometer has been flourishing since the passed decade in our nation. Many general hospitals use it for routine tests. One of the main usage is immunophenotyping for hematological malignancies. Flowcytometric immunophenotyping (FCM IM) facillitates accurate diagnosis in both leukemias and lymphoid proliferative disorders (LPDs). It becomes an indispensable criteria in the diagnosis of hematological malignancies. It may also offer additional therapeutically relevant information. Typical patterns of immunophenotype in leukemias and certain types of LPDs are illustrated in figure 1 and figure 2. But variation or overlapping appears often. In order to reach a definitive diagnosis and to have a common interpretaion between laboratory to laboratory the following items need not to be ignored: ① Direct staining and multi color or multi parameter flow cytometric analysis is necessary. ② The phenotype of abnormal cells should be determined on as pure a population as possible therefore CD45/SSC gating is critical for isolating the blast population (abnormal cells). CD45/SSC gating is much better than FSC/SSC gating especially when percentage of blast is low in the sample. Else, each subtype of leukemia has its special CD45/SSC pattern. ③ The phenotype of this certain population should be discribed clearly but it is not necessary to count the percentage of each markers. ④ >20% for positive threshold used in indirect staining method may be confused in multi color direct staining method. ⑤ Hybrid leukemia diagnosed by FCM only should be in caution since the divergence of antigen/antibody, the lineage infidelity of antigen expression and the biological characteristics of the leukemic cells. Flowcytometer is not a cell counter. 'It provides a pattern of information that must be interpreted by a knowledgeable professional in the context of the clinical situation'.

关 键 词：流式细胞仪 免疫分型 白血病 淋巴瘤 流式细胞术 

分 类 号：R733.7[医药卫生—肿瘤] R446.6[医药卫生—临床医学]