95例初治急性T淋巴细胞白血病患者免疫表型特点

摘要

本研究分析我国急性T淋巴细胞白血病(T-ALL)的免疫表型特点及其临床意义.利用4色多参数流式细胞术检测95例T-ALL患者免疫表型,回顾性分析患者的临床及实验室指标.结果表明:①T-ALL患者以年轻男性(＜30岁)为主,发病时常伴有外周血高WBC和髓外浸润；发病时年龄＜30岁的患者CR1率明显高于≥30岁的患者(p =0.049)；②据wHO(2008)造血和淋巴组织肿瘤分类标准,本组患者Pro-T-ALL占31.0％,Pre-T-ALL占35.6％,皮质T-ALl占26.4％,髓质T-ALL占6.9％；CD34在Pre-T-ALL中的表达率显著低于Pro-T-ALL(p=0.001)；Pre-T-ALL的CRI率显著高于Pro-T-ALL(p =0.001)；不成熟T-ALL(包括Pro-T-ALL和Pre-T-ALL)的CRI率显著低于成熟T-ALL(皮质-T-AL和髓质T-ALL) (p=0.029)；③髓系抗原CD13、CD33在与T-ALL亚型及治疗效果的关系方面存在差异.66.7％的CD13+患者属于Pre-T-ALL,而大多数CD33+患者归为Pro-T-ALL；CD13+与CD13 -患者的CR1率差别无统计学意义,而CD33+患者的CR1率显著低于CD33-组(p=0.00l)；④以≥20％为阳性界线,CD117在本组T-ALL的表达率高达26.7％,且阳性患者集中分布(95.0％)于Pro-T-ALL和Pre-T-ALL中；⑤CD34-患者的CD117表达较均一,73.2％患者CD117表达水平＜l0％；而CD34+组中CD117的表达不一,CD117表达水平＜10％、10％ - 20％、＞20％的患者分别占44.2％、17.3％、38.5％,与CD34-组相比,CD117表达水平＜10％、＞20％的患者在CD34+组中的比例均较高,两组差别显著(P值分别为0.006和0.019).结论:T-ALL的抗原表达情况与疾病的免疫分型、亚型判断以及临床治疗效果密切相关,利用流式细胞术有助于发现在T-ALL临床及生物学研究方面有潜在价值的免疫标记.%The objective of this study was to investigate the immunophenotye of T-lineage acute lymphoid leukemia (T-ALL) and to find valuable immunologic markers in T-ALL diagnosis and therapy. Four-color multiparametric flow cytometry( FCM) with CD45/SSC gating was used for immunophenotyping of 95 patients with newly diagnosed T-ALL. The results demonstrated that T-ALL occurred more frequently in males younger than 30 years of age and was usually accompanied by a high WBC count and tumor mass at diagnosis. Univariate analysis showed an influence on achievement of CR1 for age ( <30 years) but not for WBC count and tumor mass. According to WHO (2008) clsssification of tumors of haematopoietic and lymphoid tissues, 87 patients with confirmed subtype included 27 cases of Pro-T-ALL (31.0% ) , 31 cases of Pre-T-ALL ( 35.6% ), 23 cases of cortical-T-ALL ( 26.4% ) , 6 cases of medullary-T-ALL (6.9% ). CD34 expression in Pro-T-ALL was significantly higher than that of Pre-T-ALL (p =0.001). After the first chemotherapy, the complete remission rate in Pro-T-ALL was statistically lower than that of Pre-T-ALL. Besides, the complete remission rate of immature T-ALL(including Pro-T-ALL and Pre-T-ALL) was also significantly lower than that in mature T-ALL (including cortical-T-ALL and medullary-T-ALL). Myeloid antigen (CD13.CD33) expression was associated with T-ALL subtype and treatment effect. While 66.7% of CD13 * patients belonged to Pre-T-ALL, most (60.0% ) of CD33 * patients were classified into Pro-T-ALL;CD 13 expression had no effect on CR1 rate wheres CD33 * patients had worse treatment effect compared with CD33 " groups(p =0.001). Notebly .the expression of CD117 reached up to 26. 7% and the positive cases were primarily distributed in pro-T-Tall and pre-T-ALL. It is found that CD117 expression in CD34 " group was homogeneous and CD117 expression level was less than 10% in 73.2% patients, but CD117 expression levelin CD34* group was not homogenous, in which group the CD117 expression levels < 10% , 10% -20% and >20% were 44. 2% , 17. 3% and 38. 5% respectively. As compared with CD34" group, the proportion of patients with CD117 expression levels < 10% , >20% in CD34* group was higher, and there was significant difference between these 2 group. It is concluded that immunophenotype has great value in T-ALL diagnosis, classification as well as treatment. Flow cytometry provides access to find valuable immunologic markers for T-ALL biological research.