急性早幼粒细胞白血病细胞形态分类体系及其与实验室检查和FLT3-ITD突变的相关性分析  

Analysis of Morphologic Classification System for Acute Promyelo-cytic Leukemia and Its Correlation with Laboratory Tests and FLT3-ITD Mutation

作　　者：何婉婷[1] 陈佳琦 任雨悦 高玉娟[1] 刘红星 王巍[3] HE Wan-Ting;CHEN Jia-Qi;REN Yu-Yue;GAO Yu-Juan;LIU Hong-Xing;WANG Wei(Department of Hematology,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,Heilongjiang Province,China;Department of Laboratory Medicine,Hebei Yanda Lu Daopei Hospital,Langfang 065201,Hebei Province,China;Department of Hematology,The Second Affiliated Hospital of Harbin Medical University,Harbin 150086,Heilongjiang Province,China)

机构地区：[1]哈尔滨医科大学附属第一医院血液内科,黑龙江哈尔滨150001 [2]河北燕达陆道培医院检验医学科,河北廊坊065201 [3]哈尔滨医科大学附属第二医院血液内科,黑龙江哈尔滨150086

出　　处：《中国实验血液学杂志》2024年第5期1334-1342,共9页Journal of Experimental Hematology

摘　　要：目的:建立一套用于表征急性早幼粒细胞白血病(APL)患者细胞形态特点的分类体系,并分析不同APL细胞形态特点与常规检验指标和基因变异的相关性。方法:根据APL白血病细胞的形态特征,建立一套14类的分类体系用以表征患者个体间和个体内的细胞形态异质性。将该分类体系用于40例APL患者的形态学分析,并将分类结果与患者的常规检验指标和基因变异特点进行统计学分析,以分析不同APL细胞形态特征与常规检验指标和基因变异的相关性。结果:FLT3-ITD突变阳性的APL病例组中核形规则、粗颗粒且不见Auer小体(1类)的细胞显著少于FLT3突变阴性病例组(P<0.05)。核形规则组相比于核形不规则组活化部分凝血活酶时间(APTT)明显较长(P<0.05);细颗粒组相比于粗颗粒组APTT明显较长(P<0.01)、骨髓白血病细胞比例相对更低(P<0.05);Auer小体阴性组的外周血白细胞计数、D-二聚体、乳酸脱氢酶和骨髓白血病细胞比例均显著高于Auer小体增多组(均P<0.05)。结论:本研究建立的形态学分类体系可以客观表征不同类型的APL白血病细胞,有助于更好地评估APL白血病细胞的个体内和个体间异质性和进一步用于精确分析APL的形态表型与生物学特性的相关性。Objective:To establish a morphologic classification system for characterizing blast cells in patients with acute promyelocytic leukemia(APL)and analyze the correlation of different APL morphologic characteristics with conventional tests and genetic variants.Methods:Based on the morphological characteristics of APL blast cells,a classification system of 14 categories was established to characterize the inter-and intra-individual cellular morphological heterogeneity of patients.The classification system was used for the morphological analysis of 40 APL patients,and the classification results were statistically analyzed with the patients'conventional test indexes and gene variant characteristics to analyze the correlation of different APL blast cell morphological features with conventional test indexes and gene variants.Results:In the FLT3-ITD mutation-positive group,there were significantly fewer cells with regular nuclear shape,hyper granularity,and missing Auer rods(category 1)than in the FLT3 mutation-negative group(P<0.05).The activated partial thromboplastin(APTT)was significantly longer in the group with regular nucleus compared to the group with irregular nucleus(P<0.05).In the hypo-granular group,the APTT was also significantly longer compared to the hyper-granular group(P<0.01),and the proportion of myeloid blast cells was relatively lower(P<0.05).The peripheral blood white blood cell counts,D-dimer,lactate dehydrogenase and proportion of bone marrow blast cells were significantly higher in the Auer rods(-)group than Auer rods increasing group(all P<0.05).Conclusion:The newly established morphologic classification system in this study can objectively characterize different types of APL blast cells,which helps to better assess the intra-and inter-individual heterogeneity of APL blast cells,and further use in accurately analyzing the correlation of morphological phenotypes with biological properties of APL.

关 键 词：急性早幼粒细胞白血病 细胞形态分类 实验室检查 FLT3-ITD突变 

分 类 号：R733.71[医药卫生—肿瘤]