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  本文選題：急性白血病　切入點：CD34　出處：《寧夏醫(yī)科大學》2012年碩士論文　論文類型：學位論文

【摘要】：目的探討CD34抗原在小兒急性白血病（AL）中的表達與臨床表現(xiàn)及化療療效的關系。 方法采用流式細胞術分別檢測85例急性淋巴細胞白血�。ˋLL）及42例急性髓系白血�。ˋML）初診患兒骨髓CD34的表達陽性率，比較ALL和AML患者CD34表達的差異。觀察AL患者臨床特征與療效，比較CD34表達與非CD34表達患者臨床表現(xiàn)差異和治療效果。 結果1.85例ALL患兒CD34陽性率為43.52%，42例AML患兒CD34陽性率為47.61%，AML組CD34表達略高于ALL組(P0．05)，但無統(tǒng)計學差異。2..CD34在AML-M3亞型中為低表達或不表達，有統(tǒng)計學意義；CD34在ALL-L3型中為低表達，，但統(tǒng)計學分析無意義。3.在AL預后因素分析中，CD34的陽性表達率與性別、外周血白細胞計數(shù)、血紅蛋白濃度、血小板數(shù)量等無明顯差異；但在ALL患兒中腫瘤浸潤(肝脾、淋巴結腫大)表現(xiàn)上有統(tǒng)計學差異（X2=3.99，P=0.046），而在AML中肝脾淋巴結腫大等征象上均無明顯差異。4.含CD34的表達的ALL在誘導治療4周的緩解率上無統(tǒng)計學差異（P0.05）；AML患兒在誘導化療療效方面，CD34+組完全緩解率為35.0%，明顯低于CD34-組的72.72%（X2=6.019，P=0.014）,5.AML細胞CD34的過度表達是AML預后不良因素之一。 結論AML患者骨髓細胞CD34表達略高于ALL組。CD34在AML-M3亞型中為低表達或不表達；AML組CD34的表達與性別、外周血白細胞數(shù)、血紅蛋白濃度、血小板數(shù)量及腫瘤浸潤(肝脾，淋巴結腫大)等表現(xiàn)上無相關性；其在誘導4周化療后完全緩解率上與CD34抗原表達陰性者相比有統(tǒng)計學意義。CD34在ALL-L3型中表達較其他亞型低，ALL組CD34表達與性別、外周血白細胞數(shù)、血紅蛋白濃度、血小板數(shù)量等無明顯相關性；但肝脾，淋巴結腫大等腫瘤浸潤等臨床征象上有統(tǒng)計學差異；而在誘導治療4周的緩解率上差異無明顯相關性。CD34抗原表達可能是AML的一個預后不良因素。
[Abstract]:Objective to investigate the expression of CD34 antigen in children with acute leukemia. Methods the positive rates of bone marrow CD34 expression in 85 cases of acute lymphoblastic leukemia (ALL) and 42 cases of acute myeloid leukemia (AMLL) were detected by flow cytometry. To compare the difference of CD34 expression between ALL and AML patients, to observe the clinical characteristics and curative effect of AL patients, to compare the clinical manifestations and therapeutic effects between CD34 expression and non-#en4# expression. Results 1.The positive rate of CD34 in 85 cases of ALL was 43.52%. The positive rate of CD34 in 42 cases of AML was 47.61%. The expression of CD34 was slightly higher in group A than that in group ALL (P 0.05), but there was no statistical difference in the expression of CD34 in AML-M3 subtype, but the expression of CD34 was low in ALL-L3 type. However, there was no significant difference between the positive expression rate of CD34 and sex, peripheral white blood cell count, hemoglobin concentration and platelet count in the prognostic factor analysis of AL, but there was no significant difference in tumor infiltration (liver and spleen, liver and spleen) in children with ALL. There was statistical difference in the manifestation of lymphadenopathy. There was no significant difference in the signs of hepatosplenomegaly in AML. 4. There was no significant difference in remission rate of ALL with CD34 expression in 4 weeks of induction treatment. In terms of therapeutic effect, the complete remission rate of CD34 group was 35.0, which was significantly lower than that of CD34- group (72.72%). The overexpression of CD34 in AML cells was one of the factors contributing to the poor prognosis of AML. Conclusion the expression of CD34 in bone marrow cells of AML patients is slightly higher than that in ALL group. CD34 expression and sex, peripheral white blood cell count, hemoglobin concentration, platelet count and tumor infiltration (liver and spleen) are lower or not in AML-M3 subtype. The expression of CD34 in ALL-L3 group was lower than that in other subtypes, the expression of CD34 and sex, the number of peripheral blood leukocytes, and the number of peripheral blood leukocytes in all group were significantly lower than those in other subtypes, and the complete remission rate after 4 weeks of chemotherapy was significantly higher than that in patients with negative expression of CD34 antigen, and the expression of CD34 was significantly lower in ALL-L3 type than in other subtypes. There was no significant correlation between hemoglobin concentration and platelet count, but there were statistical differences in clinical signs such as liver and spleen, lymph node enlargement and tumor infiltration. However, there was no significant correlation between the remission rate of induced therapy and 4 weeks of treatment. The expression of CD34 antigen may be a poor prognostic factor in AML.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R733.71

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