本文關(guān)鍵詞：急性髓系白血病免疫表型特征及其臨床意義，由筆耕文化傳播整理發(fā)布。

        目的：探討成人急性髓系白血病細(xì)胞免疫表型與預(yù)后的關(guān)系。方法：148例急性白血病初治患者，其中急性髓系白血病（acute myeloid Leukemia,AML）140例，急性混合型白血�。╩ixed aleukemia, MAL）8例。采用流式細(xì)胞術(shù)方法分析患者的免疫表型。然后按白血病不同類(lèi)型給予標(biāo)準(zhǔn)誘導(dǎo)緩解方案化療：AML予DA或IA方案（M3除外）；M3采用ATRA或ATRA+As2O3（全反式維甲酸、三氧化二砷）聯(lián)合化療方案；MAL采用TOAP、DOLP方案，并觀察其治療效果。分析比較各免疫表型（CD13、CD33、CD64、CD34、HLA-DR、CD56、CD11b、CD64、CD14等）陽(yáng)性患者與陰性患者之間的完全緩解率（completeremission）、 AML中伴淋系抗原表達(dá)者（Ly+-AML）與無(wú)伴淋系抗原表達(dá)者（Ly--AML）間的完全緩解率是否存在差異。結(jié)果：1．本組148例AML患者中，根據(jù)細(xì)胞形態(tài)學(xué)特征不能分型的6例，經(jīng)過(guò)細(xì)胞免疫學(xué)檢測(cè)，根據(jù)其細(xì)胞表面或胞漿抗原表達(dá)特點(diǎn)得以確診，其中M12例，M54例。另4例形態(tài)學(xué)診斷為ALL患者，免疫學(xué)分型確診為MAL。其余138例與FAB診斷相符，符合率93.24%。2．148例患者中，有8例MAL，140例AML。AML患者中，M4發(fā)病率最高，其次為M5、M2、M3、M1，而M6發(fā)病率最低。各種抗原表達(dá)陽(yáng)性率由高到低依次為CD38、CD13、CD33、HLA-DR、CD64、CD34、CD11b、CD56、CD14；140例AML中伴淋系表達(dá)占49.3%（69例），69例LY+AML中淋系抗原最常見(jiàn)為CD7（43例）、其余依次為CD19（12例），CD4（9例子）、CD2（5例），CD20檢測(cè)為陰性。M3中CD34及HLA-DR表達(dá)水平明顯低于其他亞型白血病，CD56較常見(jiàn)表達(dá)。3．148例AL中，僅95例患者可判斷療效。95例白血病患者經(jīng)誘導(dǎo)治療后，54例取得完全緩解，總緩解率為56.84%；其中53例AMLCR，CR率57.61%（53/92）；1例MAL CR，CR率33.3%（1/3）。4．AML患者中，淋系免疫表型CD7+CR率明顯低于CD7-患者CR率，兩者間差別具統(tǒng)計(jì)學(xué)意義（P<0.05）；CD19+CR率高于CD19-CR率，兩者差別具顯著性（P<0.05）。92例AML患者中，Ly+-AML47例，CR率46.81%，Ly--AML42例，CR率68.89%，兩者間差異具統(tǒng)計(jì)學(xué)意義（P>0.05）。5．CD7、CD19與CD34抗原表達(dá)一致性較高，且CD34、CD7雙陽(yáng)性患者CR率低于CD34+、CD7-患者的CR率，兩者間存在統(tǒng)計(jì)學(xué)差異；而CD34、CD19雙陽(yáng)性患者CR率高于CD34+、CD19-患者CR率，差異有統(tǒng)計(jì)學(xué)意義；CD34、CD11b（成熟粒細(xì)胞抗原標(biāo)志）雙陽(yáng)性患者CR率明顯低于CD34+、CD11b-患者CR率，且差異有統(tǒng)計(jì)學(xué)意義；CD56、CD11b雙陽(yáng)性M5患者CR率低于雙陰性M5患者CR率，但差異無(wú)統(tǒng)計(jì)學(xué)意義。6．祖/干細(xì)胞免疫表型CD34+-AML CR率（57.14%）低于CD34--AMLCR率（58.33%），兩者間差別無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；HLA-DR+-AMLCR率（57.58%）低于HLA-DR--AMLCR率（57.69%），兩者間差別無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；CD38+-AMLCR率（60%）高于CD38--AMLCR率（41.67%），差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論：1．免疫表型分析有助于確診一些特殊類(lèi)型的白血病，在急性白血病的診斷分型中有重要意義；急性髓系白血病CD13、CD33高表達(dá)，CD34、HLA-DR表達(dá)低下甚至缺如，，尤其非雙陽(yáng)性患者，可作為M3的較為特異的免疫學(xué)表型以協(xié)助診斷。2．AML可以表現(xiàn)為髓系抗原與CD7、CD19等淋系抗原共表達(dá)，結(jié)果顯示Ly+AML患者的化療療效差；單一非淋系相關(guān)抗原的表達(dá)對(duì)于急性髓系白血病預(yù)后判斷的意義仍需進(jìn)一步探討，而不同抗原異常同步表達(dá)（如CD34+CD7+、CD34+CD19+、CD34+CD11b+）對(duì)于白血病的預(yù)后判斷具一定價(jià)值。3．CD56、CD11b作為M5的不良預(yù)后因素而有待關(guān)注；MAL具有髓系和淋系雙重特征，療效差。

    Objective:To explore the immunophenotyp of leukemia cells and its clinical significance inacute leukemia（AL）patients.Methods:There are148cases of acute leukemia patients, including140cases of acutemyeloid leukemia and8cases of acute mixed leukemia. The immunophenotype of allpatients were analyzed with flow cytometry. Acute myeloid leukemia （non-M3） weretreated with the regimen of DA or IA; M3were treated with ATRA or ATRA+As2O3（all-trans retinoic acid, arsenic trioxide）which combined with chemotherapy; MALwere treated with the regimen of TOAP or DOLP; and then observation of curativeeffect. Analyzing the difference of CR rate between lymphoid antigen positive AMLand lymphoid antigen negative AML, and the difference of CR rate between myeloidantigen positive AL and myeloid antigen negative AL.Results:1. Six cases in the group of148patients, which cann’t typed by the cellmorphology were diagnosed with immunological detection according to the cellsurface or intracellular antigen expression characteristics, including2cases of M1,4cases of M5. It was about93.24%equal with immHnophenotyping-diagnosis andFAB-diagnosis．2. In148patients, there were8cases of mixed leukemia,140patients with AML.In AML patients, M4incidence was the highest, followed by M5, M2, M3, M1, M6andminimum morbidity.In140patients with AML antigen expression from high to low asCD38、CD13, CD33, HLA-DR, CD64, CD34, CD11b, CD56, CD14; lymphoidantigen CD7, CD19,CD4,CD2express in AML, CD20is negative. The expressionlevel of CD34and HLA-DR in M3was significantly lower than the other subtypes ofAML, CD56more common. 3. The CR rate of AML is56.84%（53/93）, the rate of MAL is33.3%（1/3）.4. The CR rate of CD7+-AML was39.28%（11/28）, which was lower than65.63%（42/64） from CD7--AML（P<0.05）. The CR rate of CD19+-AML was91.67%（11/12）, which was higher than52.50%（42/80） from CD19--AML（P<0.05）.And, the CR rate of Ly+AML was46.81%（22/47）,while Ly-AML was68.89%（31/45）,there was statistical significance amony them（P<0.05）.5. CD34, CD7antigen expression of high consistency, and the CR rate in doublepositive patients is lower than the patients with CD34positive and CD7negative,there is significant difference between the two; while the CR rate in CD34, CD19double positive patients is higer than the patients with CD34positive and CD19negative, and the difference was statistically significant; CD34, CD11b doublepositive patients in remission rate higher than that of CD34+, CD11b-patients inremission rate, but the difference was not statistically significant.6. The CR rate of CD34+-AML was57.14%（32/56）, which was lower than58.33%（21/36） from CD34--AML（P>0.05）. The CR rate of HLA-DR+-AML was57.58%（38/66）, which was litter lower than57.69%（15/26） fromHLA-DR--AML（P>0.05）. And, the CR rate of CD38+-AML was60%（48/80）,whileCD38--AML was41.68%（5/12）, there was no statistical significance amonythem（P>0.05）.Conclusion:1.Immunophenotyping of leukemia cells could be helpful for classification ofsome specific type of acute leukemia and has important clinical significant ineva1uating the prognosis of AL.2.The expression of a single antigen for leukemia prognostic significance stillneeds a further study; expression of antigen abnormal synchronization for leukemiamay have some value（CD34+CD7+, CD34+CD19+, CD34+CD11b+）.3.CD56and CD11b have improtant significance in the diagnosis and prognosisof M5; Myeloid antigen and lymphoid antigen are positive in MAL, the curativeeffect of MAL is worse.

        急性髓系白血病免疫表型特征及其臨床意義

中英文縮略詞表4-5中文摘要5-7英文摘要7-8前言9-11材料與方法11-13結(jié)果13-20討論20-27結(jié)論27-28參考文獻(xiàn)28-30致謝30-31綜述31-46    參考文獻(xiàn)42-46

  本文關(guān)鍵詞：急性髓系白血病免疫表型特征及其臨床意義，由筆耕文化傳播整理發(fā)布。