急性双表型白血病细胞形态学和免疫表型的研究

摘要

Objective To discuss the diagnostic value of myeloid immunophenotype in detection the biphenotypic acute leukemia (BAL) and to compare the value with morphology of bone marrow cells .Methods Immunophenotype of 190 patients with acute leukemia(AL) were detected by four‐color direct immunofluorescence staining methods of flow cytometry(FCM ) .And by morphol‐ogy of bone marrow cells ,the immunophenotype were analyzed .Four‐color direct immunofluorescence staining methods combined with CD45/SSC gating analysis was used to analyze immunophenotype of 11 cases with BAL according the standard score of EGIL . Results Among 190 cases with AL ,88 cases were acute myeloid leukemia (AML ) ,which accounted for 46 .3% ,and 88 cases (46 .3% ) were acute lymphocytic leukemia(ALL) and 3 cases(1 .6% ) were undifferentiated AL .These results had a high coinci‐dence rate with morphology of bone marrow cell and tissue chemistry diagnosis .Among 190 cases with AL ,11 cases(5 .8% ) were diagnosed of acute BAL .Amomg of them ,7 cases(3 .7% ) expressed of B lymphoid and myeloid together which showed that both cCD79a and cMPO immunophenotyping were expressed ,meanwhile the expression of membrane antigen CD19 and CD10 was high‐er .Three cases(1 .6% ) expressed T lymphoid and myeloid together which showed that both cCD3 and cMPO immunophenotyping were expressed ,and the expression of membrane antigen CD7 and CD5 was higher .Only one case(0 .5% ) expressed B ,T and mye‐loid .Patients with BAL showed high expression of membrane antigen CD34(81 .8% ) indicating poor prognosis .Conclusion The incidence of BAL is low and immunophenotype of morphology of bone marrow cells is a very specific diagnosis of BAL .The co‐ex‐pression of B lymphoid and myeloid antigen is major feature of BAL .Combination detection of morphology of bone marrow cell and flow cytometry in patients with BAL could improve the diagnostic accuracy ,which can effectively guide the clinical treatment and judge prognosis .%目的：探讨骨髓细胞免疫表型在急性双表型白血病中的诊断价值及其与骨髓细胞形态学的比对研究。方法对190例急性白血病患者采用流式细胞仪四色免疫荧光直接标记技术检测细胞免疫表型，通过骨髓细胞形态学分型进行分析。采用流式细胞术四色免疫荧光直接标记技术与 CD45／SSC 设门分析技术检测11例双表型急性白血病患者，根据欧洲白血病免疫分类协作组（EGIL）积分标准进行免疫学分型。结果190例急性白血病中被免疫分型诊断为急性髓系白血病88例（占46．3％），急性淋系白血病88例（占46．3％），未分化白血病3例（占1．6％），与骨髓细胞形态学和组织化学诊断具有高符合率。190例急性白血病中被免疫分型诊断为急性双表型白血病11例（占5．8％），其中髓系与 B 系共表达的抗原7例（占3．7％），均共同表达cCD79a 和 cMPO ，胞膜抗原 CD19和 CD10表达量较高；髓系与 T 系共表达的抗原3例（占1．6％），均共同表达 cCD3和 cMPO ，胞膜抗原 CD5和 CD7表达量较高；髓系、B 系与 T 系均表达的抗原1例（占0．5％）。此外，急性双表型白血病患者高表达 CD34胞膜抗原（占81．8％），提示预后不良。结论急性双表型白血病发病率较低，骨髓细胞免疫表型对诊断及鉴别双表型急性白血病有特异性，以髓系和 B 系抗原共表达为主。采用骨髓细胞形态学和流式细胞术联合检测急性双表型白血病可提高诊断准确性，能有效地指导临床制订治疗方案和进行预后判断。