38例慢性淋巴细胞白血病的诊断分析  

Diagnostic analysis of 38 cases of chronic lymphocytic leukemia

作　　者：胡建娥[1] 杨丽萍 李良琼[1] 

机构地区：[1]重庆三峡中心医院检验科,404000

出　　处：《检验医学与临床》2017年第A02期138-141,共4页Laboratory Medicine and Clinic

摘　　要：目的 分析慢性淋巴细胞白血病（CLL）的临床表现、细胞学、免疫表型和细胞遗传学的特点及其在CLL中的诊断价值.方法 回顾性分析我院38例初诊CLL患者的临床资料和实验室检查结果.结果 初诊CLL患者具有一些特征性的临床表现：全身多处淋巴结肿大最常见（77.3% ）,其次为脾大（59% ）、贫血（43% ）,而血小板减少、肝大及发热并不常见;外周血白细胞均值68.3×109/L、淋巴细胞均值58.9×109/L、淋巴细胞比例的均值为84.5%,血清乳酸脱氢酶（LDH）为135~550U/L,22.0%大于正常值上限;免疫表型分析示所有患者均表达CD19,而 HLA-DR、CD79a、CD20、CD23、及CD5表达也很常见,阳性率依次为97.3%、93.5%、89.5%、88.2%、78.4%,CD22、cIgm弱表达,CD5＋和CD5-B系抗原表达无显著性差异（P〉0.05）;7例 Fish检查结果显示：共发现6种遗传学异常,分别为del（13q14.3）、del（13q14）、＋12、t（14,16）（q32;q21.3）、CSP12位点扩增、IGH异常信号,其中del（13q14.3）、del（13q14）较常见,检出率分别为（42.9% ）和 （28.6% ）,存在≥1种细胞遗传学异常率为85.7% （6/7）,仅有1种细胞遗传学异常的有3例,有2种细胞遗传学的有2例,有3种细胞遗传学的有1例,分别占所有被检患者的43%、28.6%、14.3%.结论 CLL患者的免疫表型和细胞遗传学的检查有一定的特点,对CLL的诊断和预后有重要价值,临床表现和的骨髓细胞学检查具有辅助诊断价值.Objective To investigate the diagnosis value of clinical manifestations、cytologic examination、immunophenotype and cytogenetic features of chronic lymphocytic leukemia （CLL）.Methods Clinical records and laboratory features of 38 patients from our institution with CLL diagnosed were retrospectively reviewed.Results Most of the patients had typical clinical manifestations when newly diagnosed：77.3% cases with lymphadenectasis,59% cases with splenomegaly,43% cases with anaemia while thrombo-cytopenia、hepatomegaly and fever are not common.The mean of WBC of peripheral blood is 68.3×109/L,of lymphocyte count is 58.9×109/L and of lymphocyte proportion is 84.5%.The levels of LDH：135~550U/L,22.% cases were supernormal.The re-sults of immunophenotype indicated that among 38 cases the positive rates of CD19 was 100%,followed by HLA-DR （97.3% ）, CD79a （93.5% ）,CD20（89.5% ）,CD23（78.4% ）,CD5（78.4% ）,while CD22、cIgm slightly expressed.All cases were divided into two groups by CD5＋ and CD5-.There was not significant difference in the expression of the major antigens of B-cell CLL between the two groups（P〉0.05）.7 cases were analysed by fluorescence in situ hybridization （FISH）.We find 6 kinds of aberrations in a-bove cases：13q14.3 deletion,13q14.3 deletion,trisomy 12,t（14,16）（q32;q21.3）,CSP12 amplification、IGH abnormality.The most frequent abnormality was 13q14.3 deletion,which was detected in 3 （42.9% ）patients,followed 13q14.3 deletion in 2 （28.6% ）pa-tients.6 patients （85.7% ）had at least one aberration.In particular,3 （42.9% ）patients had a single abnormality and 2（28.6% ） patients had two abnormalities and 1 （14.3% ）patient had three abnormalities.Conclusion Immunophenotyping and cytogenetic features play a significant role in the diagnosis and prognosis of CLL.However,they have restriction of specificity.Clinical manifes-tations and cytogenetic features have assistant diagnostic value.We should combine typical clinical manifestations,the c

关 键 词：慢性淋巴细胞白血病 免疫表型 回顾性研究 

分 类 号：R733.72[医药卫生—肿瘤]