【摘要】 目的:分析儿童急性淋巴细胞白血病(ALL)免疫表型特点,探讨不同表型ALL缓解率及预后的差别。方法:采用流式细胞仪CD45/侧散射(SSC)双参数散点图设门方法对128例形态学分型为ALL的患儿幼稚细胞表面分化抗原进行分析,并与细胞组织化学(FAB分型)进行比较。对所有ALL患儿进行化疗,比较完全缓解率的差异。结果:128例患儿形态学与免疫学检查符合率为81.25%,有16例形态学误诊被免疫分型纠正。128例ALL患儿中104例表达淋系抗原,纯B系抗原表达52例,纯T系抗原表达22例,淋系中可合并髓系抗原表达,30例伴有髓系抗原表达,主要表达CD33、CD13,4例ALL-L2为纯髓系表达,8例诊断为急性髓细胞白血病伴淋系表达,8例为未分化型,4例急性混合型白血病同时表达2种以上淋系和髓系抗原标志,其中在B-ALL中CD19敏感性最高,在T-ALL中CD7敏感性最高,HLA-DR、CD34等非系列相关抗原在儿童ALL中均有较高表达。伴髓系表达的ALL完全缓解率低于无髓系表达者(χ2=17.26,P=0.028)。结论:免疫分型能助诊一些特殊类型的白血病,是对白血病细胞形态学诊断的重要补充。儿童ALL采用形态学结合免疫学分型可获得T、B细胞来源、肿瘤细胞分化阶段和异常抗原表达等参数,有助于临床预后的判断。更多还原

【Abstract】 Aim:To study the immunophenotypical characteristics of acute lymphoblastic leukemia(ALL)and to investigate the complete remission and the prognosis of the different immunophenotypic ALL.Methods:Multiparameter flow cytometry and CD45/SSC gating were used to analyze the surface antigen expression in 128 cases of ALL and was compared with FAB subtype.The chemotherapies to all the ALL patients were carried out.Results:The results showed that the consistency rate of 128 patients was 81.25% between morphology and immunology,and 16 morphologic misdiagnosed cases were corrected by immunology.Lymphoid antigens were expressed in 104 of 128 patients with ALL and B or T lymphoid antigens were detected alone in 52 or 22 patients,respectively.And myeloid lineage-associated antigens were also found in ALL.30 patients with ALL showed aberrant myeloid antigens expression such as CD33 and CD13.Myeloid antigens were expressed alone in 4 ALL-L2 patients.8 patients were also diagnosed AML for myeloid antigens were expressed along with aberrant lymphoid antigens expression.8 patients were acute unidentified leukemia.4 patients with mixed acute leukemia showed lymphoid and myeloid antigens more than two kinds.In B-ALL CD19 was the most susceptible cluster designations.In T-ALL CD7 was the most sensitive cluster designations.Un-serial antigens including HLA-DR and CD34 had high positive expression rate.And complete remission(CR)rate of My+-ALL was significantly lower than that of My--ALL(χ2=17.26,P=0.028).Conclusion:Immunophenotype has diagnostic value to some special types of ALL children and it is the important complement to morphology.Multiparameter FCM could not only provide data of cell lineage and differentiation status but also detect phenotypic aberrancies,which is helpful for judging prognosis.更多还原