105例儿童白血病的免疫分型与形态结果分析

摘要

目的 研究儿童白血病骨髓细胞形态学及免疫分型之间的关系.方法 对本院2016年新收治的105例儿童白血病进行回顾性分析,总结其流行病学特点及白细胞抗原的表达情况.结果 (1)ALL、AML患儿男女比例分别为2.13∶1,1.44∶1;中位发病年龄分别为3岁,2岁.(2) 105例儿童白血病FAB合型:初诊急性髓系白血病(AML) 22例,急性淋巴细胞白血病(ALL) 72例,未分类急性白血病2例,慢性粒细胞白血病(CML)4例,幼年型粒-单核细胞白血病(JMML)2例,神经母细胞瘤(NB)骨髓浸润2例,淋巴瘤骨髓转移1例;72例急慢性白血病免疫分型:急性髓系白血病(AML)16例,急性B淋巴细胞白血病(B-ALL) 47例,急性T淋巴细胞白血病(T-ALL)4例,慢性粒细胞白血病(CML)2例,幼年型粒-单核细胞白血病(JMML)1例,淋巴瘤骨髓转移1例,未见明显异常1例.(3)免疫分型与形态学分型完全符合率为91.67％(66/72),部分符合率为2.78％(2/72),完全不符合率为5.55％(4/72).(4)CD19、CD34、CD10、HLA-DR在儿童急性B淋巴细胞白血病中表达高,分别为100.00％(47/47)、80.85％(38/47)、89.36％(42/47)、100.00％(47/47);CD20在儿童急性B淋巴细胞白血病中表达均为12.77％(6/47);而CD13和CD33在儿童急性B淋巴细胞白血病中的表达率均为21.28％(10/47).结论 免疫分型对儿童白血病的诊断有重要作用,但并不能完全取代形态学分析,同时弥补了骨髓常规检查的不足.%Objective To study the relationship between the morphology of bone marrow cells and the immunological classification in diagnosing children with leukemia.Methods A total of 105 children with leukemia treated at our hospital in 2016 were retrospectively analyzed;the epidemiological characteristics and the expression of leukocyte antigen were summarized.Results (1) The ratioes of male and female in ALL and AML were 2.13∶1 and 1.44∶1,respectively;the median onset age was 3 years old and 2 years old,respectively.(2) Among the 105 children with leukemia,22 were acute myeloid leukemia (AML),72 acute lymphoblastic leukemia (ALL),2 unclassification acute leukemia,4 chronic myeloid leukemia (CML),2 juvenile myelomonocytic leukemia (JMML),2 neuroblastoma (NB) bone marrow infiltration,and 1 lymphoma with bone marrow metastasis by FAB-classifying standard;among the 72 cases of acute and chronic leukemia immune,16 cases were acute myeloid leukemia (AML),47 acute B lymphocytic leukemia (B-ALL),4 acute T lymphocytic leukemia (T-ALL),2 chronic myeloid leukemia (CML),1 juvenile granulocyte monocyte nuclear cell leukemia (JMML),1 lymphoma with bone marrow metastasis,and 1 showed no obvious abnormalities by immunophenotyping.(3) The diagnostic coincidence rate between the immunophenotyping and morphological classification was 91.67％ (66/72),the partial coincidence rate was 2.78％ (2/72),and the innconsistent diagnosis rate was 5.55％ (4/72).(4) CD19,CD34,CD10,and HLA-DR were highly expressed in childhood B-cell acute lymphoblastic leukemia,with detection rates of 100.00％ (47/47),80.85％(38/47),89.36％ (42/47),and 100.00％(47/47),respectively;the expression rate of CD20 in childhood B-cell acute lymphoblastic leukemia was 12.77％ (6/47) and CD13 and CD33 expression rates were both 21.28％ (10/47).Conclusions Immunophenotyping plays an important role in the diagnosis of childhood leukemia,but it can not completely replace morphological analysis,and it can make up the deficiency of the conventional examination of bone marrow.