髓系抗原阳性与儿童急性淋巴细胞白血病临床相关性  

Correlation analysis of positive myeloid antigen and clinical feature of children with acute lymphoblastic leukemia

作　　者：裴晓杭 张茵[1] 马保根[1] 陈玉清[1] 牛晓娜[1] 赵俊歌[1] 

机构地区：[1]河南省人民医院血液科,郑州450003

出　　处：《中华实用儿科临床杂志》2015年第3期211-215,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省医学科技攻关计划（200904056）

摘　　要：目的探讨儿童急性淋巴细胞白血病（ALL）患者髓系抗原表达与临床相关性。方法回顾性分析2010年1月至2013年12月河南省人民医院血液科收治的77例初治ALL患儿临床资料。其中，男53例，女24例；中位年龄7．73（2．00—15．00）岁。根据流式细胞术免疫分型分为髓系抗原表达阳性（MyAg^＋ALL）组；髓系抗原表达阴性（MyAg—ALL）组。分析髓系抗原表达与临床特征、泼尼松试验、诱导化疗第15天骨髓象及第33天微小残留病（MRD）的关系，并比较2组患儿的无病生存率。结果77例儿童ALL患者中伴髓系抗原表达者共26例（占33．77％），其中以CD13^＋表达为主，占19．48％（15／77例）；其次CD33^＋占10．39％（8／77例），CD117^＋占5．19％（4／77例）。其中CD13^＋CD33^＋患儿2例，CD33^＋CD117^＋患儿1例。MyAg^＋ALL组性别（χ^2=0．217，P=0．641）、年龄（≥10岁,χ^2=0．011，P=0．918）、白细胞计数（≥50×10^9／L，χ^2=1．198，P=0．274）、乳酸脱氢酶计数（~〉500U／L，χ^2=0．317，P=0．573）、遗传学异常（χ^2=0．377，P=0．539）、免疫分型（B—ALL／T-ALL,χ^2=0．397，P=0．529）及危险度分层（低危、中危、高危,χ^2=0．260，P=0．878）与MyAg^-ALL组比较差异均无统计学意义。单因素Logistic回归分析显示MyAg^＋ALL组泼尼松试验反应差率（P=0．023，OR=3．422）及MRD阳性率（P=0．001，OR=0．133）显著高于MyAg^-ALL组。多因素Logistic回归显示CD13^＋ALL组MRD阳性率显著高于CD13^-ALL组（P=0．034，OR=120．765）。CD13^＋ALL组与CD13^-^-ALL组累计无病生存率分别为（50．4±13．8）％和（77．4±6．7）％，2组比较差异有统计学意义（χ^2=3．928，P=0．047）。结论儿童ALL髓系抗原与大多数临床特征无明显相关性，伴髓系抗原表达阳性患儿的诱导化疗早期反应差，伴CD13表达患儿的预后较差。Objective To explore the correlation of the myeloid antigen expression and clinical characteristics of acute lymphoblastic leukemia （ALL） in children. Methods The clinical data of 77 newly diagnosed ALL patients in Department of Hematology, the People＇s Hospital of Zhengzhou University from Jan. 2010 to Dec. 2013 were analyzed. The patients included 53 boys and 24 girls with a median age of 7.73 （2.00 - 15.00） years old. Based on flow cytometry （FCM） analysis of bone marrow, these patients were divided into 2 groups ： one group included 26 patients with positive myeloid antigen expression （MyAg ^＋ ALL） and the other group included 51 patients with negative myeloid antigen expressions （MyAg^- ALL）. The correlation among myeloid antigen expression, clinical features, prednisone experiment,myelogram on the 15^th day was analyzed through induction chemotherapy and minimal residual disease （MRD） on the 33rd day,and the rate of disease -free survival （DFS） was compared between the 2 groups. Results There were 26 cases with myeloid antigen expression among 77 patients （ 33.77% ）, CD13 ^＋ accounting for 19.48% （ 15/77 cases） ,CD33 ^＋ 10.39% （8/77 cases） ,and CD117 ^＋ 5.19% （4/77 cases）. Among these patients,there were 2 patients expressing both CD13 ^＋and CD33 ^＋,and 1 patient expressing both CD33 ^＋and CD117 ^＋There was no difference between the MyAg^＋ ALL group and MyAg-ALL group in gender （χ^2 = 0. 217 ,P = 0. 641 ） , age （ ≥ 10 years old,χ^2 = 0. 011 ,P =0. 918） ,white blood count（ ≥50 × 10^9/L,χ^2 = 1. 198 ,P =0. 274）, lactate dehydrogenase （LDH） （ ≥500 U/L,χ^2 = 0. 317 ,P = 0. 573 ）, genetic abnormality （χ^2 = 0. 377, P = 0. 539 ）, immunophenotype （B-ALL/T-ALL,χ^2 = 0. 397, P = 0. 529 ）, and risk stratification （ low - risk group, middle - risk group and high - risk group ,χ^2 = 0.260, P = 0. 878 ）. Univariate Logistic regression showed that the reaction rate of prednisone experiment （ P = 0. 023, OR =

关 键 词：急性淋巴细胞白血病 髓系抗原 预后 儿童 

分 类 号：R733.71[医药卫生—肿瘤]