CD15在急性髓系白血病患者中表达及其临床意义  

Expression of CD15 and its clinical significance in patients with acute myeloid leukemia

作　　者：窦留瑞 魏圣洁 李丹 肖梦宇 李梦一 孙晓白 王豪言 白炎亮 孙恺 DOU Liu-rui;WEI Sheng-jie;LI Dan;XIAO Meng-yu;LI Meng-yi;SUN Xiao-bai;WANG Hao-yan;BAI Yan-liang;SUN Kai(Department of Hematology,Zhengzhou University People fs Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学人民医院河南省人民医院血液科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2022年第4期370-373,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81971508,81471589);河南省科技攻关计划省部共建项目(201201005);河南省科技厅基础与前沿项目(142300410078)。

摘　　要：目的 观察急性髓系白血病(acute myeloid leukemia, AML)患者骨髓白血病细胞CD15的表达情况,探讨其与预后的关系。方法 初诊AML患者188例均行至少2个疗程诱导化疗。治疗前采用流式细胞术检测患者骨髓白血病细胞CD15的表达情况,以白血病细胞表面抗原表达≥20%为阳性;根据CD15表达情况将患者分为CD15;AML组91例和CD15;AML组97例。比较2组初诊时外周血白细胞计数、血清乳酸脱氢酶水平、法美英(French-American-British, FAB)分型等临床资料及白血病细胞免疫表型特征。诱导化疗后第21~28天评估疗效,比较2组完全缓解率;随访1~52个月,比较2组完全缓解者复发率,采用Kaplan-Meier生存曲线分析2组3年总生存率、无事件生存率。结果 CD15;AML组初诊时外周血白细胞计数[22.7(4.8,55.6)×10^(9)/L]、血清乳酸脱氢酶水平[474(302,742)u/L]、FAB-M5型比率(26.4%)均高于CD15;AML组[7.8(2.6,29.7)×10^(9)/L、344(211,597)u/L、5.2%](P<0.05),FAB-M2型比率(46.2%)低于CD15;AML组(67.0%)(χ^(2)=8.329,P=0.004);2组血红蛋白水平、血小板计数、白蛋白水平、骨髓原始细胞比率、外周血原始细胞比率及危险度分层比较差异均无统计学意义(P>0.05)。CD15;AML组HLA-DR、CD64阳性表达率(94.5%、79.1%)高于CD15;AML组(81.4%、46.4%)(χ^(2)=7.461,P=0.006;χ^(2)=21.399,P<0.001);2组CD34、CD38、CD117、CD33、CD13、CD123、CD7、CD11b、CD56和CD71阳性表达率比较差异均无统计学意义(P>0.05)。CD15;AML组完全缓解率(84.6%)高于CD15;AML组(71.1%)(χ^(2)=4.919,P=0.027),完全缓解者复发率(33.8%)低于CD15;AML组(55.1%)(χ^(2)=6.710,P=0.010)。CD15;AML组3年总生存率(50.5%)及无事件存生率(38.1%)均低于CD15;AML组(67.4%、58.7%)(χ^(2)=5.548,P=0.019;χ^(2)=7.988,P=0.005)。结论 AML患者CD15阳性表达提示化疗敏感,预后良好。Objective To observe the expression of CD15 in patients with acute myeloid leukemia(AML) and to investigate its relationship with prognosis. Methods Totally 188 patients with initially diagnosed AML received 2-course induction chemotherapy. The expression of CD15 in myeloid leukemia cells was detected by multi-parameter flow cytometry before therapy. CD15 expression ≥20% was defined as positive. According to the CD15 expression, 188 patients were divided into CD15;AML group(n=91) and CD15;AML group(n=97). The blood cell count, lactate dehydrogenase level, French-American-British(FAB) classification, and immunophenotypic characteristics were compared between two groups. By day 21 to 28 after induction chemotherapy, the efficacy was evaluated and the complete remission rate was compared between two groups. After 1-to 52-month follow-up, the relapse rate was compared in patients with complete remission. Kaplan-Meier survival curve was used to analyze the overall survival rate and event-free survival rate in two groups. Results The white blood cell count, lactate dehydrogenase level and percentage of FAB-M5 subtype were higher in CD15;AML group [22.7(4.8, 55.6)×10^(9)/L, 474(302, 742) u/L, 26.4%) than those in CD15;AML group [7.8(2.6, 29.7)×10^(9)/L, 344(211, 597) u/L, 5.2%)(P<0.05), and the percentage of FAB-M2 subtype was lower in CD15;AML group(46.2%) than that in CD15;AML group(67.0%)(χ^(2)=8.329, P=0.004). No statistically significant differences were found in haemoglobin level, platelet count, albumin level, bone marrow primitive cell ratio, peripheral blood primitive cell ratio and risk stratification between two groups(P>0.05). The percentages of patients with HLA-DR antibody and CD64 positive expression were higher in CD15;AML group(94.5%,79.1%)than those in CD15-AML group(81.4%,46.4%)(χ^(2)=7.461,P=0.006;χ^(2)=21.399,P<0.001).There were no significant differences in the positive rates of CD34,CD38,CD117,CD33,CD13,CD123,CD7,CD11b,CD56and CD71between two groups(P>0.05).The complete remission rate was h

关 键 词：急性髓系白血病 CD15 免疫表型 预后 

分 类 号：R733.71[医药卫生—肿瘤]