儿童急性淋巴细胞白血病免疫分型特征及其临床意义

Immunophenotyping and its clinical significance in childhood acute lymphoblastic leukemia

摘要:

目的：探讨急性淋巴细胞白血病（ALL）患儿的免疫分型及其与临床特征的关系。方法：139例ALL患儿为研究对象，取肝素抗凝的骨髓或静脉血2~3 mL，利用流式细胞仪进行免疫分型分析。结果：139例ALL患儿中，B-ALL 103例（74.1 %），T-ALL 24例（17.3 %），T/B双表型ALL 12例（8.6 %）。B-ALL主要表达的抗原有CD19（90.3%）、CD10（83.5%）、CD20（27.2%)。T-ALL主要表达的抗原有CD3（79.2%）、CD7（66.7%）、CD5（33.3%）。B/T-ALL主要表达的T系抗原有CD7（50.0%）、CD5（41.7%）；B系抗原有CD19（50.0%）、CD10（33.3%）。139例ALL患儿中，32例伴髓系抗原表达（My+），主要表达的抗原有CD13、CD33、CD14、MPO等。139例ALL患儿中，31例表达CD34；而My+ ALL中CD34阳性表达（15.6%）明显低于My- ALL（24.3%）。139例ALL患儿中，82例表达HLA-DR。CD10、CD34、HLA-DR在标危、中危、高危型ALL中的表达差异有统计学意义。My+ ALL组性别、出血发生率与My- ALL组比较差异有统计学意义（P<0.05）。结论：免疫分型可正确区分儿童ALL的来源。CD10、CD34、HLA-DR抗原表达与ALL的临床分型有关。

Abstract:

OBJECTIVE: To study the immunophenotype and its relationship with clinical characteristics in children with acute lymphoblastic leukemia (ALL). METHODS: Bone marrow or blood samples (2-3 mL) with heparin anticoagulation from 139 children with ALL were obtained, and immunophenotypes were identified by flow cytometry. RESULTS: In 139 ALL children, there were 103 cases (74.1%) of B-ALL, 24 cases (17.3%) of T-ALL, 12 cases of T/B biphenotypic (8.6% of T/BALL). In the 103 children with B-ALL, CD19 (90.3%), CD10 (83.5%) and CD20 (27.2%) were expressed as major antigens. In the 24 children with T-ALL, the major antigens were CD3 (79.2%), CD7 (66.7%) and CD5 (33.3%). In the 12 children with B/T-ALL, T-lymphoid antigens included CD7 (50.0%) and CD5 (41.7%), while the B-lymphoid antigens included CD19 (50.0%) and CD10 (33.3%). Of the 139 children with ALL, 32 cases (23.0%) showed myeloid antigen expression (My+ ALL) and the main expression antigens were CD13, CD33, CD14 and MPO. CD34 was expressed in 31 cases. CD34-positive expression (15.6%) in My+ ALL children was significantly lower than in My-ALL children (24.3%). HLA-DR was expressed in 82 of the 139 ALL children. The expression of CD10, CD34 and HLA-DR in the standard-risk, medium risk, high-risk ALL children was significantly different. There were significant differences in gender and incidence of bleeding between the My+ ALL and My-ALL groups (P<0.05). CONCLUSIONS: Immunetyping can differentiate the sources of leukemic cells. The expression of CD10, CD34 and HLA-DR antigen is related to the clinical classification of ALL.