运用CLLflow积分系统诊断中国B细胞慢性淋巴细胞增殖性疾病的研究  

Study on diagnosis of B cell chronic lymphocytic proliferative diseases in China using CLLflow score system

作　　者：商芳影 郑金娥[2,3] 马耀坤 贺艳丽 李娟[2,3] 胡宇 杜雯[2,3] SHANG Fangying;ZHENG Jine;MA Yaokun;HE Yanli;LI Juan;HU Yu;DU Wen(Flow Cytometry Laboratory,Wuhan Kindstar Medical Laboratory Co.,Ltd,Wuhan,4300749 China;Department of Stem Cell,Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology;Biological Targeted Therapy,Key Laboratory in Hubei)

机构地区：[1]武汉康圣达医学检验所有限公司流式细胞实验室,武汉430071 [2]华中科技大学同济医学院附属协和医院干细胞科 [3]生物靶向治疗研究湖北省重点实验室

出　　处：《临床血液学杂志》2021年第12期841-846,共6页Journal of Clinical Hematology

摘　　要：目的:运用CLLflow积分系统诊断与鉴别诊断包括慢性淋巴细胞白血病(CLL)在内的B细胞慢性淋巴细胞增殖性疾病(B-CLPD)。方法:回顾性分析2018年3月—2020年6月就诊的363例B-CLPD患者,根据疾病类型分成CLL组(185例)和非CLL(non-CLL)组(178例),分别对其进行CD分子染色,经流式细胞仪前向/侧向散射光(FSC/SSC)和CD45设门,对2组标本中各类细胞进行分群,选择CD19;细胞,分析该群细胞的表型,并同时进行CLLflow和Matutes积分统计,比较CLL组和non-CLL组间2种积分以及各CD分子表达差异。结果:2组CLLflow和Matutes积分比较,差异均有统计学意义(P<0.01);CLLflow与Matutes积分的灵敏度比较,差异无统计学意义(98.4%vs 95.7%,P>0.05),然而,CLLflow积分特异度明显高于Matutes积分(89.9%vs 64.6%,P<0.01)。CLLflow积分的中位数随着MS分数的增加而增加。2组间CD5、CD10、CD23、CD79b、FMC7的表达差异均有统计学意义(P<0.01)。2组间CD20、CD22表达差异无统计学意义(P>0.05)。CD5/CD23双阳性对CLL的诊断表现出了高敏感度和特异度(P<0.01)。Kappa/Lambda双阴性在CLL组中更为多见(P<0.01)。CD200在CLL组的表达率明显高于non-CLL组(P<0.01)。结论:运用复合免疫标记的CLLflow积分系统在诊断与鉴别诊断包括CLL在内的B-CLPD时有用性高。与Matutes积分相比,CLLflow积分灵敏度相当,特异度显著提高,稳定性更好。Objective: To diagnose and differentiate chronic lymphocytic leukemia(CLL) and other B-cell chronic lymphoproliferative disease(B-CLPD) using CLLflow score system. Methods: A retrospective analysis was performed on 363 patients with B-CLPD in Wuhan Union Hospital from March 2018 to June 2020. According to the types of diseases, the patients were divided into CLL group(185 cases) and non-CLL group(178 cases). The samples of the two groups were labeled by a series of monoclonal antibodies and all cells were definitely classified using the foward/side scatter(FSC/SSC) and CD45 gating for flow cytometric analysis. CD19;cells were selected and we analyzed the phenotypes of cell population, and simultaneously CLLflow scores and Matutes scores was calculated respectively. The differences of two kinds of scores and the expressions of each CD molecules were compared between the CLL group and the non-CLL group. Results: There were significant differences between CLL group and non-CLL group in CLLflow score and Matutes score(P<0.01). There was no significant difference in sensitivity between CLLflow score and Matutes score(98.4% vs 95.7%, P>0.05). However, the specificity of CLLflow score was significantly higher than that of Matutes score(89.9% vs 64.6%, P<0.01). The median of CLLflow scores increased with the increase of MS scores. The median of CLLflow scores increased with the increase of Matutes scores. The expressions of CD5, CD10, CD23, CD79 b and FMC7 between the two groups were statistically significant(P<0.01). There were no significant differences in the expressions of CD20 and CD22 between the two groups(P>0.05). CD5/CD23 double positive showed high sensitivity and specificity for CLL diagnosis(P<0.01). Kappa/Lambda double negative were more common in CLL group(P<0.01). The rates of CD200 expressions in CLL group were significantly higher than that in non-CLL group(P<0.01). Conclusion: The CLLflow score system using a combination of immunomarkers may be more useful in the diagnosis and differential diagnosis of

关 键 词：慢性淋巴细胞白血病 CLLflow积分系统 流式细胞术 CD200 

分 类 号：R733.72[医药卫生—肿瘤]