57例急性早幼粒细胞白血病的实验室检查及临床诊疗分析  

Analysis of laboratory examination, diagnosis and treatment of 57 cases of acute promyelocytic leukemia

作　　者：曹鹏飞[1] 柏彬[2] 黄文滨[3] 张国平[1] 陈方平[1] 

机构地区：[1]中南大学湘雅医院血液科,长沙410008 [2]永州职业技术学院附属医院检验科,湖南省永州425000 [3]中南大学湘雅医学院检验系,长沙410008

出　　处：《中国医师杂志》2016年第4期520-523,526,共5页Journal of Chinese Physician

基　　金：国家自然科学基金（81570117）

摘　　要：目的 探讨初诊急性早幼粒细胞白血病（APL）患者的实验室检查及临床诊疗分析.方法 对2011年1月至2013年12月间在中南大学湘雅医院初诊为APL的57例患者的临床表现、实验室形态学、免疫学、遗传学及分子生物学（MICM）分型、治疗及随访等方面进行回顾性分析.结果 57例患者中,首发症状以出血为主占73.7％,以发热为主占26.3％,以器官浸润为主占29.8％;57例患者中流式分析结果为CD13＋ CD33＋ CD34-HLD-RA-者34例,占59.6％,CD13＋ CD33＋CD34＋HLD-RA＋者5例,占8.8％,其余18例均为不经典表型;57例患者中用荧光原位杂交（FISH）技术检测PML/RARa融合基因,阳性53例,占93.0％;除1例放弃治疗外,56例APL患者经过快速的早期筛查诊断,相对规范有效的治疗后,达到了100％的完全缓解率.结论 出血为M3最常见的临床症状,MICM分型（尤其FISH技术）是诊断M3的主要实验室依据,经过早期规范的治疗M3可以基本治愈.Objective To investigate the laboratory examination,diagnosis and treatment of 57 cases of Acute Promyelocytic Leukemia.Methods The clinical manifestation,laboratory morphology-immunology-cytogenetics-molecular （MICM） classification,treatment and follow-up were analyzed retrospectively among 57 newly diagnosed cases of acute pmmyelocytic leukemia （APL） patients from January 2011 to December 2013 in Xiangya Hospital,Central South University.Results In 57 patients,the first symptom was given priority to with bleeding （73.7%）,fever （26.3%）,and the organ infiltration accounted for 29.8%.The phenotype of CD13 ＋ CD33 ＋ CD34-HLD-RA-was 59.6% in 57 patients,CD13 ＋ CD33 ＋CD34 ＋ HLD-RA ＋ was 8.8%,and the remaining 18 cases were not classic phenotypes.The positive percentage of PML/RARa was 93.0% by fluorescence in situ hybridization （FISH）,and the remaining 4 cases were other rare abnormal.Except one case gave up the treatment,the other 56 cases of APL patients reached 100% complete remission rate under early screening and diagnosis,relatively standardized and effective treatment.Conclusions Hemorrhage is the most common clinical symptoms of M3.MICM classification,especially the FISH technology,is the main laboratory basis for diagnosis of M3.After the treatment of early specifications currently,M3 can almost be cured.

关 键 词：白血病 早幼粒细胞 急性/诊断/治疗 

分 类 号：R733.71[医药卫生—肿瘤]