160例儿童急性白血病免疫表型分析

Analysis of the immunophenotype of 160 cases of childhood acute leukemia

摘要:

目的 免疫表型可以确定细胞的来源和分化阶段 ,是急性白血病的重要生物学特征。该文了解儿童急性白血病 (AL)抗原表达规律、分布情况并探讨其临床意义。方法 采用流式细胞术直接或间接免疫荧光法检测 1 6 0例儿童AL的免疫表型。结果 1 6 0例AL中 ,急性淋巴细胞白血病 (ALL) 1 1 2例 ,急性髓细胞白血病(AML) 4 8例。 1 1 2例ALL中 ,T系ALL 1 2例 (1 0 .7% ) ;B系ALL(不包括成熟B ALL) 93例 (83.0 % )。ALL中 ,1 3.8%有髓系抗原表达 ,以CD33阳性最常见 ;AML中 ,4 0 %有淋系抗原表达 ,以CD7阳性率最高。儿童AML淋系抗原表达阳性率高于儿童ALL髓系抗原表达 (P <0 .0 1 )。CD1 4在儿童M 4和M 5的表达频率为 77.8%。B系ALL中CD34阳性率 5 8.5 %。AML中 ,CD34的表达频率为 5 5 .3% ,其中M1和M 2的CD34阳性率为 76 .5 % ,高于其它AML病人的CD34阳性率 (4 3.3% ) ,P <0 .0 5。HLA DR抗原在M 3的表达频率为 1 1 .1 % ,低于其它类型AML病人的HLA DR阳性率 (76 .3% ) ,P <0 .0 1。B系ALL中 ,CD34表达与FAB分型、起病时白细胞数、髓外侵润情况均无关 (P >0 .0 5 ) ;CD34-组婴幼白血病发生率 (1 7.6 % )高于CD34+ 组 (4 .2 % ) ,P <0 .0 5。结论 HLA DR阴性对于M3的诊断具有一定参考价值。

Abstract:

Objective The immunophenotype, which can identify origins and differentiation phases of cells, is an important biological character of childhood acute leukemia (AL). This paper aims at studying the characteristics and distribution of childhood AL. Methods The cell surface or cytoplasma antigens were detected by flow cytometry with a standard direct or indirect immunofluorescence assay in 160 children with AL. Results Among the 160 cases of AL, 112 were acute lymphoblastic leukemia (ALL) and 48 were acute myelogenous leukemia (AML). Among the 112 cases of ALL, 12 were T lineage ALL (T ALL) ( 10.7% ) and 93 were B lineage ALL (B ALL) (apart from mature B ALL) ( 83.0% ); the myeloid antigen expression was noted in 13.8% of the cases with the most common expression of positive CD33. Among the 48 cases of AML, the lymphoid antigene expression was positive in 40%, with the highest frequency of CD7. The frequency of the lymphoid antigen expression in AML cases was higher than that of the myeloid antigen expression in ALL cases (P< 0.01 ). The frequency of CD14 expression in childhood M4 and M5 AML was 77.8% . The positive CD 34 of the B ALL cases was found in 58.5% of the cases, and that of the AML cases in 55.3% of the cases, in which those of M1 and M2 AML cases was 76.5% , higher than those of the cases with other types of AML ( 43.3% ) (P< 0.05 ). The HLA DR expression was 11.1% in M 3 AML cases, lower than that in the other types of AML cases ( 76.3% ) (P< 0.01 ). Among the B ALL cases, the CD34 expression was un related to the French American British classification, initial WBC counts and extramedullary infiltration. The incidence of infantile leukemia in cases with negative CD34 ( 17.6% ) was higher that in cases with positive CD34 ( 4.2% ) (P< 0.05 ). Conclusions The detection of HLA DR expression may be helpful in the diagnosis of M3 AML.