陳瑛 陳海娟 王萍

[摘要] 目的 探討流式細(xì)胞儀免疫分型在急性白血病（AL）患者中的表達(dá)特點(diǎn)、診斷價(jià)值及其預(yù)后意義，為建立個(gè)體化的治療提供指導(dǎo)。 方法 回顧性對(duì)我院收治的62例初發(fā)AL患者的骨髓細(xì)胞形態(tài)學(xué)、流式細(xì)胞儀免疫分型檢測(cè)結(jié)果進(jìn)行對(duì)比分析，了解二者診斷相符率。結(jié)合細(xì)胞遺傳學(xué)及分子生物學(xué)檢查結(jié)果進(jìn)行預(yù)后分析，之后分組觀察患者治療反應(yīng)及生存情況。 結(jié)果 5例急性白血病患者通過骨髓細(xì)胞形態(tài)學(xué)和組織化學(xué)檢查未能明確分型診斷，經(jīng)流式細(xì)胞儀免疫分型檢測(cè)后確定。2例骨髓細(xì)胞形態(tài)與流式細(xì)胞儀免疫分型結(jié)果不符，結(jié)合細(xì)胞遺傳學(xué)特點(diǎn)，予以修正診斷。AML及ALL均存在跨系表達(dá)抗原，AML常見的跨系抗原表達(dá)為CD56、CD7、CD19。ALL常見跨系抗原表達(dá)為CD13、CD15、CD33。部分分子遺傳學(xué)異?？蓪?duì)應(yīng)有異?？乖磉_(dá)，AML中CD7表達(dá)常伴有FLT3/ITD突變。AML伴t（8;21）（q22;q22）/AML1-ETO陽性患者中，60%左右表達(dá)CD19。在療效觀察中發(fā)現(xiàn)伴有預(yù)后不良染色體核型或分子遺傳學(xué)標(biāo)志的老年性急性髄系白血病患者（年齡≥70歲）中，非化療組總生存期（OS）與化療組相比無差異性（P>0.05）。 結(jié)論 流式細(xì)胞儀免疫分型檢測(cè)可以提高急性白血病分型診斷的準(zhǔn)確性，結(jié)合細(xì)胞遺傳學(xué)和分子生物學(xué)可有效地指導(dǎo)臨床制定治療方案和預(yù)后判斷。

[關(guān)鍵詞] 急性白血病;流式細(xì)胞術(shù);免疫表型;預(yù)后分析

[Abstract] Objective To investigate the expression characteristics， diagnostic value and prognostic significance of flow cytometry immunophenotyping in patients with acute leukemia（AL）， and to provide guidance for the establishment of individualized treatment. Methods The bone marrow morphological and flow cytometry immunophenotyping results of 62 patients with initial AL admitted in our hospital were retrospectively analyzed to understand the diagnostic coincidence rate. The prognostic analysis was performed by combining the results of cytogenetics with molecular biology examination. And then the treatment response and survival of the patients were observed in groups. Results Five patients with acute leukemia were not diagnosed by bone marrow cell morphology and histochemical examination， and were identified by flow cytometry immunophenotyping. The morphology of 2 cases bone marrow cells was inconsistent with the results of flow cytometry immunophenotyping， and combined with cytogenetic characteristics， the diagnosis was corrected. Both AML and ALL had cross-line expression antigens， and common cross-line antigens of AML expressed were CD56， CD7 and CD19. The common cross-line antigens ALL expressed were CD13， CD15， CD33. Some molecular genetic abnormalities may correspond to abnormal antigen expression， and CD7 expression in AML was often accompanied by FLT3/ITD mutation. In AML patients with t（8;21）（q22;q22）/AML1-ETO positive， about 60% expressed CD19. In the efficacy observation， it was found that there was no significant difference in overall survival （OS） between the non-chemotherapy group and the chemotherapy group in the elderly patients with acute sputum leukemia （age≥70 years） with poor prognosis karyotype or molecular genetic markers（P>0.05）. Conclusion Flow cytometry immunophenotyping can improve the accuracy of acute leukemia typing diagnosis， which can effectively guide clinical planning and prognosis combined with cytogenetics and molecular biology.