含CD200的改良型Matutes免疫标志积分系统在诊断慢性淋巴细胞白血病中的应用  

Application of modified Matutes score containing CD200 in diagnosis of chronic lymphocytic leukemia

作　　者：李文锦 方鹏[2,3,4,5] 傅敢 梁慧[2,3,4,5] 彭敏源 LI Wenjin;FANG Peng;FU Gan;LIANG Hui;PENG Minyuan(Department of Hematology,Jiangxi Pingxiang People’s Hospital,Pingxiang Jiangxi 337055;Department of Hematology,Xiangya Hospital,Central South University,Changsha 410008;National Clinical Research Center for Geriatric Diseases,Xiangya Hospital,Changsha 410008;Hunan Hematology Oncology Clinical Medical Research Center,Changsha 410008;National Clinical Research Center for Hematologic Diseases,First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]江西省萍乡市人民医院血液科,江西萍乡337055 [2]中南大学湘雅医院血液科,长沙410008 [3]国家老年疾病临床医学研究中心(湘雅医院),长沙410008 [4]湖南省血液肿瘤临床医学研究中心,长沙410008 [5]国家血液系统疾病临床医学研究中心,苏州大学附属第一医院,苏州215006

出　　处：《中南大学学报（医学版）》2022年第12期1689-1694,共6页Journal of Central South University ：Medical Science

基　　金：萍乡市科技计划项目(2019PY024)。

摘　　要：目的:免疫标志分型技术是诊断与鉴别诊断慢性淋巴细胞白血病(chronic lymphocytic leukemia,CLL)及其他B细胞慢性淋巴增殖性疾病(B-cell chronic lymphoproliferative diseases,B-CLPD)的重要手段。CD200在CLL中普遍强表达。本研究旨在分析含有CD200的改良型Matutes免疫标志积分(modified Matutes score,MMS)系统在诊断CLL中的临床应用价值。方法:回顾性分析2020年1月至2021年7月确诊的103例B-CLPD患者,其中CLL 64例、滤泡性淋巴瘤(follicular lymphoma,FL)11例、套细胞淋巴瘤(mantle cell lymphoma,MCL)14例、边缘区淋巴瘤(marginal zone lymphoma,MZL)6例,毛细胞白血病(hairy cell leukemia,HCL)1例、淋巴浆细胞淋巴瘤/华氏巨球蛋白血症(lymphoplasmic lymphoma/Waldenstrom macroglobulinemia,LPL/WM)7例。比较CLL组及非CLL组CD分子表达的差异,并比较MMS与英国马斯登皇家医院(Royal Marsden Hospital,RMH)免疫标志积分系统在诊断CLL中的敏感性、特异性及与临床的一致性。结果:CLL组及非CLL组在CD5、CD23、FMC7、CD22、CD79b、CD200、sIg表达上差异均有统计学意义(χ^(2)值分别为37.42、54.98、30.71、11.67、55.26、68.48、17.88,均P<0.01)。在诊断CLL上,RMH免疫标志积分≥4时,敏感性79.7%,特异性100%;MMS≥3时,敏感性95.3%,特异性100%。RMH免疫标志积分系统Kappa系数为0.677,MMS系统Kappa系数为0.860。结论:与RMH免疫标志积分系统比较,含有CD200的MMS系统在诊断CLL上有更好的敏感性、相同的特异性,且与临床有更高的吻合度。Objective:Immunophenotyping technique is a powerful tool for the diagnosis and differential diagnosis of chronic lymphocytic leukemia(CLL)and other B-cell chronic lymphoproliferative diseases(B-CLPD).CD200 is strongly expressed in CLL.This study aims to analyze the clinical value of modified Matutes score(MMS)containing CD200 in the diagnosis of CLL.Methods:We retrospectively analyzed 103 B-CLPD patients diagnosed from January 2020 to July 2021,including 64 CLL patients,11 follicular lymphoma(FL)patients,14 mantle cell lymphoma(MCL)patients,6 marginal zone lymphoma(MZL)patients,1 hairy cell leukemia(HCL)patient,and 7 lymphoplasmic lymphoma/Waldenstrom macroglobulinemia(LPL/WM)patients.The expression of CD markers between the CLL group and the non-CLL group was compared,and the sensitivity,specificity,and clinical consistency of MMS and Royal Marsden Hospital(RMH)immunophenotyping score system were analyzed.Results:There were significant differences in the expressions of CD5,CD23,FMC7,CD22,CD79b,CD200,and sIg between the CLL group and the non-CLL group(χ^(2) values were 37.42,54.98,30.71,11.67,55.26,68.48,and 17.88,respectively,all P<0.01).When the RMH immunophenotyping score≥4,the sensitivity was 79.7%,and the specificity was 100%.When the MMS≥3,the sensitivity was 95.3%,and the specificity was 100%.The Kappa coefficient of RMH immunophenotyping system was 0.677,and the Kappa coefficient of MMS system was 0.860.Conclusion:The MMS system containing CD200 has better sensitivity and same specificity compared with RMH immunophenotyping system,and MMS system may be more useful in the diagnosis of CLL.

关 键 词：慢性淋巴细胞白血病 CD200 免疫标志积分系统 流式细胞学 

分 类 号：R733.72[医药卫生—肿瘤]