脑脊液流式细胞学检测技术在急性淋巴细胞白血病儿童并发中枢神经系统白血病中的诊断价值

摘要

本研究旨在探讨脑脊液流式细胞学检测( FCM)技术对儿童急性淋巴细胞白血病(ALL)并发中枢神经系统白血病(CNSL)的诊断价值.采用FCM技术、脑脊液常规细胞学(CC)涂片法、脑脊液常规及生化检测法对75例初诊ALL患儿首次脑脊液标本进行检测,并以9例病毒性脑炎患儿初次脑脊液检测结果作为对照.结果表明,75例初诊ALL患儿,中位发病年龄5(1 -14)岁,男女比例1.3∶1.根据CCLG-ALL2008疾病危险度分组:标危组38例,中危组22例,高危组15例.首次脑脊液检查结果显示:FCM+ CC+5例(6.7％),根据CCLG-2008中枢神经系统(CNS)状态分级:CNS-23例,CNS-32例；FCM+ CC-8例(10.7％),其中CNS-17例,CNS-21例；FCM- CC- 62例(82.7％),其中CNS-1 60例,CNS-21例,CNS-31例.本研究结果显示,FCM+ CC+,FCM+ CC -,FCM - CC -3组在CNS-1,-2,-3分布上无显著性差异(P＞0.05),考虑可能与样本数量偏小有关.9例病毒性脑炎患儿初次脑脊液CC涂片中均未见肿瘤细胞.结论:脑脊液FCM技术敏感度高,在CNS-2,CNS-3诊断上与脑脊液CC检查具有较高的一致性,并可将CC诊断的CNS-2,-3阳性率提高20％,是脑脊液CC检测方法的重要补充,在儿童ALL并发CNSL的诊断中具有重要的应用价值.%This study was aimed to explore the clinical diagnostic significance of cerebrospinal fluid detection with flow cytometry ( FCM) in children acute lymphoblastic leukemia (ALL) accompanied by central nervous system leukemia (CNSL). The 75 cerebrospinal fluid (CSF) samples of children with de novo ALL were detected by FCM, conventional cytology (CC), CSF routine tests and cytochemical examination. The results showed that among 75 de novo ALL, median age of onset was 5(1 - 14) years old, ratio of male/female was 1.3: 1. According to CCLG2008-ALL risk group protocol, there were 38 cases of standard risk(50.7% ) , 22 cases of intermedial risk(29. 3% ), 15 cases of highrisk(20%). The results of CSF detection showed FCM+ CC+ 5 cases (6.7%), FCM+CC" 8 cases(10.7%) and FCMCC" 62 cases (82.7% ). According to CNS status classified, there were 3 cases of CNS-2, 2 cases of CNS-3 in FCM + CC+ group there were CNS-1 7 cases, CNS-2 1 case in FCM+ CC" groups, there were CNS-1 60 cases, CNS-2 1 case, CNS-3 1 case in FMC" CC" group. There was no significant difference in the distribution of the CNS-1, -2, -3 among the FCM+ CC + , FCM + CC" , FCM" CC " groups (P > 0. 05). It may be related to the fewer samples. There was higher consistence between results of FCM and CC on CNS-2, -3 diagnoses. FCM increased CC diagnosis positive rate to 20%. Meanwhile, there was no malignant cell in the smear, and no abnormal lymphocytic immunophenotype could be seen in CSF samples from 9 cases of viral encephalitis. It is concluded that cerebrospinal fluid detection with FCM has higher sensitivity, which is an important supplement to CSF routine detections and has significant useful value in diagnosis of children CNSL.