重症监护室中以胸腹水首发的儿童非霍奇金淋巴瘤流式诊断及临床特点分析  

Application of flow cytometry analysis for auxiliary diagnosis of non-hodgkin＇s lymphoma among Children with serous effusion and the clinical characteristics during non-hodgkin＇s lymphoma

作　　者：夏敏[1] 孙恒娟[1] 高原[1] 廖雪莲[1] 刘亚楠[1] 蒋慧[1] 

机构地区：[1]上海市儿童医院/上海交通大学附属儿童医院检验科,200040

出　　处：《中华微生物学和免疫学杂志》2015年第7期511-516,共6页Chinese Journal of Microbiology and Immunology

基　　金：基金项目：上海市科学技术委员会科研计划项目（14411950602）

摘　　要：目的评估流式细胞术行胸腹水免疫分型在儿童非霍奇金淋巴瘤（non-hodgkin’slym-phoma，NHL）诊断中的应用特点。方法2011年2月_2013年11月上海市儿童医院重症监护室（ICU）中12例诊断NHL患儿，男11例，女1例，年龄1～13岁，对病程中首发出现胸水或腹水的患儿，均应用流式进行免疫分型分析。免疫分型抗体包括CD45、CD10、CD33、CD7、CD1a、MPO、cCD3、CD79a、CD22、CD19、CD20、CD5、CD3、κ、λ、αβ、γδ和CD56等常见的T、B和NK标记，必要时加做CD30标记。结果12例伴有胸腹水的患儿最终均确诊为NHL，其病情危重，进展迅速。流式细胞术免疫分型诊断为NHL-B系6例，其中5例为腹水，1例为胸水，B系中CD20都出现高表达；诊断为NHL-T系4例，胸水3例，胸腹水混合1例，T系中αβ或γδ出现单克隆表达；另2例出现CD30的表达，确诊为间变大细胞淋巴瘤，2例均为胸水，其细胞形态学具有异质性。结论胸腹水流式细胞术免疫分型在儿童淋巴瘤辅助诊断中具有早期、快速和准确的特点，为早期化疗及抢救争取了时间，并为化疗中联合应用美罗华等靶向药物提供依据。Objective To evaluate the practicability of using flow cytometry analysis for diagnosis of non-hodgkin＇s lymphoma （NHL） among children with serous effusion. Methods Twelve children who were diagnosed with malignant lymphoma from February 2011 to November 2013 at Shanghai Children＇s hos- pital were recruited in this study. Pleural effusion and ascites samples were collected from those children who showed serous effusion as initial symptoms and analyzed by using flow cytometry based immunophenotyping. The antibodies used for immunophenotyping included CD45, CD10, CD33, CD7, CDla, MPO, cCD3, CD79a, CD22, CD19, CD20, CD5, CD3, κ、λ、αβ、γδ,CD56 and other common markers for T, B and NK cells. Anti-CD30 antibody was used when necessary. Results All of the twelve cases with serous effusion were diagnosed with aggressive NHL. Six out of the twelve children including five cases with ascites and one case with pleural effusion showed high expression of CD20 and were classified as NHL-B type by flow eytom- etry. Three children with pleural effusion and one child with both pleural effusion and ascites were typed as NHL-T as characterized by monoclonal expression of αβ or γδ. The other two children with pleura] effusion were diagnosed with anaplastic large cell lymphoma with positive expression of CD30 and morphological het- erogeneity. Conclusion Flow cytometry analysis based immunophenotyping could be used as an auxiliary method for rapid and accurate diagnosis of lymphoma in children with serous effusions.

关 键 词：积液 儿童 非霍奇金淋巴瘤 流式细胞术 免疫表型 

分 类 号：R733.1[医药卫生—肿瘤]