【作者】 曾蓉；

【导师】 陈燕；

【作者基本信息】 华中科技大学 ， 内科学， 2008， 硕士

【摘要】 目的:了解急性红白血病的生物学特征与临床疗效的关系。方法:1、选取1995年1月至2005年6月在武汉协和医院血液科住院的29例初治M6患者作为研究对象,其中男19例,女10例,年龄在7岁～68岁,中位年龄43岁;随机同期住院的30例M2a初治患者作为对照组,其中男18例,女12例,年龄在13岁～77岁,中位年龄35岁;为进一步比较Gly-A抗原的变化,另随机选取同期住院M1患者20例,M3患者15例,M4及M5患者15例进行免疫分型作为对照。2、所有患者均行骨髓细胞学检测,免疫分型检测,部分患者行细胞遗传学检测。3、复习病例收集患者的骨髓细胞学检测结果,免疫分型检测结果,细胞遗传学检测结果,患者诱导缓解化疗方案,疗效。并且研究研究组及对照组上述指标的差异,从而初步了解M6的生物学特征及其与预后的关系。结果:①M6的外周血均可见幼稚细胞(2%～10%)及有核红细胞,骨髓穿刺细胞学检查19例伴有多系发育异常,累及二系或三系,明显高于M2a患者骨髓穿刺细胞学检查2例伴有多系发育异常(P<0.01)。②免疫分型检测表明M6 Gly-A(血型糖蛋白A)的表达率高达66.67±23.86%,明显高于其在M1,M2a,M3,M4和M5中的阳性表达率(P <0.01)。③M6高表达HLA-DR(60.00±24.79%),CD34(40.00±24.79%),CD38(33.33±23.86%),髓系抗原主要表达CD13(66.67±23.86%),MPO(33.33±23.86%),CD33(46.67±25.25%),CD15(33.33±23.86%),CD117(46.67±25.25%),部分病例伴有淋系抗原的表达,如CD3,CD4,CD19,其中CD4的表达较高达26.67%。④M6中CD38,CD33,CD15,MPO的阳性表达率低于M2。⑤9例M6病例进行了染色体的检查,4例存在核型异常,异常率达44.44%,其中复杂核型异常1例。⑥M6化疗诱导完全缓解率为29.41%,低于M2a化疗诱导完全缓解率68.18%(P<0.01)。结论:M6具有其独特的生物学特征:①伴有较高的骨髓病态造血发生率;②Gly-A是鉴别M6与其他亚型急性髓性白血病的一个重要标志;③M6对化疗相对不敏感,效果不佳。更多还原

【Abstract】 Purpose:The objective was to observe the biological characteristic and the therapeutic effect in patients with acute erythroleukemia (AML-M6).Method : 1.29 patients of acute erythroleukemia (AML-M6),from Jan.1995 to June.2005 in Wuhan Union Hospital ,were selected as investigation objective, including 19 male and 10 female, from 7 to 68 years old. The median age was 43 years old. 30 patients of AML-M2a in the same hospital at the same time were selected as contrast, including male 18 and female 12, from 13 to 77 years old, the median age was 35 years old. 20 patients of M1, 15 patients of M3, 15 patients of M4 and M5 were compared with patients of M6 in the aspect of expression of Gly-A frequency.2. All the patients were received bone marrow aspiration cytology, immunophenotype and some patients were received cytogenetic examination.3. The data of patients were reviewed, including results of bone marrow aspiration cytology, immunophenotype, cytogenetic examination, and chemotherapy. The differences between the investigation and the contrast were studied to reveal the biological characteristic and the therapeutic effect in patients of M6.Results:①There were immature cells (2%~10%) and erythroblast in peripheral blood of M6. Myelodysplastic features involving multiple haemopoietic lineages in bone marrow of 19 patients in M6 was higher than that of 2 patients in M2.②Flow cytometry indicated the expression of Gly-A frequency was significant more common in M1, M2a, M3, M4 and M5 (p<0.01).③The expression frequency of HLA-DR (60.00±24.79 % ), CD34 (40.00±24.79%), CD38 (33.33±23.86%) in M6 were common as well, the expression frequency of myeloid immunophenotypes CD13 (66.67±23.86%), MPO (33.33±23.86%), CD33 (46.67±25.25%), CD15 (33.33±23.86%), CD117 (46.67±25.25%) were common in M6. Lymphocytic immunophenotypes CD3, CD4, CD19 expressed in a part of patients with M6 and the expression of CD4 frequency was common (26.67%).④The expression frequency of CD38, CD33, CD15, MPO in M6 were less common than in M2 (P<0.01).⑤4 patients in 9 were chromosomal abnormal and abnormatility was 44.44%, one of them was complex chromosomal abnormal.⑥The complete ression rate of M6 was 29.41%, it was lower than M2 (P<0.01).⑦The difference of expression of Gly-A frequency between M6a(58.82%) and M6b(75%) had not statistical meaning. The difference of clinical therapeutic response of M6a(41.18%) had not statistical meaning of M6b(16.67%).Conclusion:M6 has its own biologic features:①The rate of multiple haemopoietic lineages in bone marrow is higher in M6.②Gly-A is sepecific immunophentype in M6, it can help diffentiating M6 from other acute myeloid leukemia types.③M6 has poor clinical therapeutic response.更多还原