急性白血病患者造血B祖细胞分析及其意义  

Analysis and Significance of Hematopoietic Progenitor B Cells in Patients with Acute Leukemia

作　　者：许艳丽[1] 王顺清[1] 毛平[1] 杜庆华[1] 

机构地区：[1]广州市第一人民医院血液科,广东广州510180

出　　处：《中国实验血液学杂志》2014年第6期1525-1530,共6页Journal of Experimental Hematology

摘　　要：正常造血B祖细胞与急性B淋巴细胞白血病细胞在形态学和免疫表型等方面极其相似,易造成诊断失误。本研究回顾性分析664份样本,通过造血B祖细胞的免疫表型鉴别并观察其在急淋、急非淋患者初诊及化疗后不同时期造血B祖细胞数量的变化,探讨其在临床中的鉴别诊断意义。采用流式细胞术检测方法,以非恶性血液病病例87份样本作为对照组,以急性白血病患者不同进展期的577份样本作为检测组(其中T-ALL 26份、BALL 261份、AM L 290份),共计664份样本通过CD34/CD10/CD19/CD45抗体组合鉴定并定量造血B祖细胞群,以不同进展期的临床状态(初诊、缓解、复发)、年龄、瘤细胞浸润度为分类基础,进行了与造血B祖细胞含量的相关性分析。结果表明:1造血B祖细胞:CD45呈阴性至弱阳性连续分布,SSC(侧向散射信号)较低,早期造血B祖细胞群CD34阳性,随着细胞成熟度的增加,CD34消失。CD19、CD10在造血B祖细胞整个阶段均为阳性,早期CD10表达强度更高。2造血B祖细胞百分含量:在对照组、T-ALL、B-ALL、AM L患者中分别为1.36%、0.60%、1.39%、0.80%;检出率分别87.4%、61.5%、83.5%、75.9%;初诊、缓解、复发组造血B祖细胞含量分别为0.37%、1.66%、0.55%。3随着年龄的增长及瘤细胞侵润度的增加,造血B祖细胞有逐渐下降的趋势。4造血B祖细胞含量超过5%的样本主要分布于白血病患者缓解期。结论:造血B祖细胞群在造血系统/非造血系统疾病中均有不同程度的存在,其数值的变化与疾病进展状态、年龄、瘤细胞浸润度密切相关。造血B祖细胞数量在化疗缓解期后有一过性增加,此阶段出现的CD19、CD10双阳性群体是否来源于正常造血细胞克隆还是恶性血细胞克隆,需谨慎诊断。利用流式细胞术多色分析的优势,优化抗体组合,准确鉴定正常造血B祖细胞对临床诊疗及微小残留病的检测均有重要意义。Normal hematopoietic B progenitor cells are similar with acute B lymphoblastic leukemia（ALL）cells in terms of morphology and immunophenotypes which easly result in misdiagnosis of diseases.This study was purposed to explore the importance of B progenitor cell（ BPC）level in differential diagnosis of hematologic diseases.A total of 664 specimens including 87 specimens from patients with non-malignant hematologic diseases as control and 577 specimens from AL patients in different progressive stage were analyzed.Out of 577 specimens 26 were collected from ALL patients261 were collected from B-ALL290 were collected from AML.The relation of different clinical status（ new diagnosisremissionrelapse）,age and degree of leukemia cell involvement with hematopoietic BPC level were analyzed through identification of CD34 /CD10 /CD19 /CD45 antibody combination and quantification of hematopoietic BPC.The results indicated that（ 1）CD45 distributed from positive to weak positiveand with very low side scatter.The early hematopoietic BPC expressed CD34 ＋,along with increasing of cell maturationthe CD34 expression gradually disappearedwhile CD19 and CD10 showed positive in whole stage of hemaropoietic BPCand early CD10 highly was expressed.（ 2）the mean percentage of hematopoietic BPC was 1.36% in control group0.60% in T-ALL1.39% in B-ALL and 0.80% in AMLthe detected rate of hematopoietic BPC in controlT-ALLB-ALL and AML were 87.4%、61.5%、83.5%、75.9%respectivelythe mean percentage of hematopoietic BPC was 0.37% at new diagnosis1.66% in remission and 0.55% in relapse.（ 3）along with increase of agethe hematopoietic BPC level generally disclined.（ 4）specimens 〉5% hematopoietic BPC were mainly found in remission stage of leukemia patients.It is concluded that the hematopoietic BPC are present in malignant and non-malignant hematologic diseases.The changes of hematopoietic BPC level correlate with disease stateage and leukemia cell involvement.The increased hematopoietic BPC level are observed most ofte

关 键 词：造血B祖细胞 多参数流式细胞术 免疫分型 急性白血病 

分 类 号：R733.71[医药卫生—肿瘤]