细胞免疫表型检测在急性白血病分型诊断中的应用价值
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摘要
目的:探讨细胞免疫表型检测在急性白血病(AL)免疫分型和亚型诊断中的应用价值。方法:选择临床常用的12种单抗,应用流式细胞术(FCM)对形态学分型初诊的56例急性髓细胞白血病(AML)和28例急性淋巴细胞白血病(ALL)进行免疫表型检测与分析。结果:(1)有54例AML与免疫表型检测结果相符(符合率为96.4%),且各型均表达3种及以上髓系抗原,约90%以上AML不表达淋系抗原。(2)在2例与免疫表型检测结果不符的AML中,1例以巨核细胞抗原特异表达为主,被纠正为M7;另1例因同时表达2种髓系和淋系抗原而确诊为急性混合性白血病(HAL)。(3)经免疫表型检测能将28例ALL精确区分为T-ALL、B-ALL和T/B-ALL 3型,除后者外,B系抗原与T系抗原均不互相表达,具有较强系列专一性表达特点;T/B-ALL同时表达T系与B系抗原。结论:细胞免疫表型检测能为AL分型和亚型诊断提供客观而精确的依据,弥补并纠正形态学分型的不足与误诊,并在AML与ALL鉴别、ALL亚型区分和发现HAL、M7等方面具有较高的特异性和独特的临床应用价值。
Objective To investigate the application value of cell immunophenotype detection in the diagnosis of acute leukemia(AL) immune type and subtype. Methods Totally 12 kinds of monoclonal antibodies and flow cytometry(FCM)were used for the detection and analysis of immunophenotype of 56 acute myeloid leukemia(AML) patients and 28 acute lymphocytic leukemia(ALL) patients diagnosed with morphological classification. Results There were 54 cases of AML matching with the detection results of immunophenotype with the accuracy of 96.4%, and each was expressed in 3 or above myeloid antigen, and about more than 90% AML did not express lymphoid antigens; in the 2 cases not matching with the detection results, there was one case with giant cell nuclear antigen specific expression was corrected as M7, and one case also expressed as 2 kinds of myeloid and lymphoid antigen was diagnosed as acute hybrid leukemia(HAL). Detected by immunophenotyping, 28 cases of ALL could be accurately distinguished as three kinds such as T-ALL, B-ALL and T/B-ALL, and except the latter, B antigen and T did not mutually express each other, with the characteristics of strong series specific expression; T/B-ALL expressed both T and B antigen. Conclusion The cell immune phenotype detection can provide objective and accurate basis for AL type and subtype diagnosis and misdiagnosis, as well as make up for the deficiency and correct morphological classification, and has specific and unique clinical application value in the aspects of distinguishing AML and ALL, differentiating ALL subtype and discovering HAL, M7 etc.
Objective To investigate the application value of cell immunophenotype detection in the diagnosis of acute leukemia(AL) immune type and subtype. Methods Totally 12 kinds of monoclonal antibodies and flow cytometry(FCM)were used for the detection and analysis of immunophenotype of 56 acute myeloid leukemia(AML) patients and 28 acute lymphocytic leukemia(ALL) patients diagnosed with morphological classification. Results There were 54 cases of AML matching with the detection results of immunophenotype with the accuracy of 96.4%, and each was expressed in 3 or above myeloid antigen, and about more than 90% AML did not express lymphoid antigens; in the 2 cases not matching with the detection results, there was one case with giant cell nuclear antigen specific expression was corrected as M7, and one case also expressed as 2 kinds of myeloid and lymphoid antigen was diagnosed as acute hybrid leukemia(HAL). Detected by immunophenotyping, 28 cases of ALL could be accurately distinguished as three kinds such as T-ALL, B-ALL and T/B-ALL, and except the latter, B antigen and T did not mutually express each other, with the characteristics of strong series specific expression; T/B-ALL expressed both T and B antigen. Conclusion The cell immune phenotype detection can provide objective and accurate basis for AL type and subtype diagnosis and misdiagnosis, as well as make up for the deficiency and correct morphological classification, and has specific and unique clinical application value in the aspects of distinguishing AML and ALL, differentiating ALL subtype and discovering HAL, M7 etc.
引文
[1]张纯,李睿,赵菲,等.急性白血病细胞形态学与免疫学分型的关系[J].中国癌症杂志,2007,17(8):615-618.
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[6]丁邦胜,翟志敏,何晓东,等.急性白血病形态学与免疫学分型[J].蚌埠医学院学报,2003,28(4):297-299.
[7]黄欣.流式细胞术用于急性白血病免疫学分型现状[J].检验医学与临床,2006,3(4):160-162.
[8]Kornblau S M,Thall P,Huh Y O,et al.Analysis of CD7expression in at cute myelogenous leukemia:martingale residual plost combined with optimal cutpoint analysis reveals absence of prognostic significance[J].Leukemia,1995,9(10):1 735-1 741.
[9]Paredes-Aguilera R,Romero-Guzman L,Lopez-Santiago N,et al.Flow cytometric analysis of cell-surface and intracellular antigens in the dignosis of acute leukemia[J].A m J Hematol,2001,68(2):69-74.
[10]孙秀丽,方美云,姜凤,等.免疫分型用于68例急性白血病分型[J].中国实验血液学杂志,2006,14(1):39-41.
[11]Preti H A,Huh Y O,Brien O,et al.Myeloidmarkers in adult lymphoblastic leukemia[J].Br J Hematol,1996,93(2):61.
[2]易丽萍,哈利达·亚森.免疫分型及临床应用[J].中国组织工程研究与临床康复,2009,13(5):903-906.
[3]张之南.血液病诊断及治疗标准[M].3版.北京:科学出版社,2007:106-113.
[4]Bene M C,Castoldi G,Knapp W,et al.Proposals for the immunological classification of acute leukemia[J].Leukemia,1995,9(10):1 783-1 786.
[5]舒文秀,陈燕.急性淋巴细胞白血病免疫分型的特点及其临床意义[J].临床血液学杂志,2005,18(2):103-106.
[6]丁邦胜,翟志敏,何晓东,等.急性白血病形态学与免疫学分型[J].蚌埠医学院学报,2003,28(4):297-299.
[7]黄欣.流式细胞术用于急性白血病免疫学分型现状[J].检验医学与临床,2006,3(4):160-162.
[8]Kornblau S M,Thall P,Huh Y O,et al.Analysis of CD7expression in at cute myelogenous leukemia:martingale residual plost combined with optimal cutpoint analysis reveals absence of prognostic significance[J].Leukemia,1995,9(10):1 735-1 741.
[9]Paredes-Aguilera R,Romero-Guzman L,Lopez-Santiago N,et al.Flow cytometric analysis of cell-surface and intracellular antigens in the dignosis of acute leukemia[J].A m J Hematol,2001,68(2):69-74.
[10]孙秀丽,方美云,姜凤,等.免疫分型用于68例急性白血病分型[J].中国实验血液学杂志,2006,14(1):39-41.
[11]Preti H A,Huh Y O,Brien O,et al.Myeloidmarkers in adult lymphoblastic leukemia[J].Br J Hematol,1996,93(2):61.