【摘要】：背景及目的急性T淋巴細胞白血病(acute T-lymphoblastic leukemia,T-ALL)是一種生物學(xué)特征異質(zhì)性很大的疾病,多見于兒童和青少年,也見于成人,發(fā)病率約占成人ALL的25%[1]。研究表明,CD34在除AML-M3以外的AML中高表達,其表達程度與預(yù)后相關(guān)[2、3],而CD34在ALL中的研究相對較少。T-ALL的免疫表型與臨床特點的研究以及免疫表型與預(yù)后關(guān)系的研究目前主要以T淋巴系常見的抗原如CD2、CD3、CD5、CD7等居多,而對于非特異性抗原CD34,國內(nèi)外的研究重點在于該抗原在造血干細胞移植中的作用,對其與預(yù)后的關(guān)系報道鮮少。T-ALL發(fā)病率較低,預(yù)后差,CD34抗原在T-ALL中的表達不高,目前人們對其生物學(xué)、免疫學(xué)等了解不足,不能通過識別可靠的預(yù)后因素調(diào)整治療方案。本研究分析CD34陽性及陰性成人急性T淋巴細胞白血病患者的臨床表現(xiàn)及預(yù)后,探討CD34表達對成人T-ALL預(yù)后的價值。方法回顧性分析鄭州大學(xué)第一附屬醫(yī)院血液科2012年1月至2015年7月收治的57例初治成人T-ALL患者,根據(jù)CD34的表達情況,分為CD34陽性組與CD34陰性組,并對兩組的臨床特點、實驗室檢查、中樞神經(jīng)系統(tǒng)白血病的發(fā)生率、化療后的4周完全緩解率及預(yù)后生存進行比較。分析CD34的表達是否影響造血干細胞移植。結(jié)果57例初治成人T-ALL患者中,CD34陽性組13例(22.8%),CD34陰性組44例(77.2%)。CD34陽性組與CD34陰性組在性別、年齡、肝脾大、淋巴結(jié)腫大、血小板減少、白細胞增高、染色體異常、4周完全緩解率(CR)率、中樞神經(jīng)系統(tǒng)白血病(CNSL)方面,差異均無統(tǒng)計學(xué)意義(均P0.05);CD34的表達與縱隔腫物無相關(guān)性(P0.05)。初診時CD34陽性組血紅蛋白(Hb)90g/L、伴髓系抗原表達者的比例高于陰性組,差異均有統(tǒng)計學(xué)意義(χ2=4.571,P=0.033;χ2=6.787,P=0.009)。治療過程中,43.2%的患者疾病復(fù)發(fā),但與CD34的表達無相關(guān)性(P0.05)。15例選擇造血干細胞移植(HSCT),42例未選擇HSCT,在未選擇HSCT的患者中,CD34陽性組中位生存期為5個月,CD34陰性組為17個月,兩者差異有統(tǒng)計學(xué)意義(χ2=4.220,P=0.040)。結(jié)論1.成人T-ALL中CD34的表達與初診時年齡、性別、肝脾腫大、淋巴結(jié)腫大、高白細胞、血小板減少、染色體異常及中樞神經(jīng)系統(tǒng)白血病的發(fā)生率無明確相關(guān)性。2.CD34的表達與縱隔腫物、疾病復(fù)發(fā)無明確相關(guān)性。3.CD34陽性組更易出現(xiàn)中、重度貧血,且與髓系抗原表達有關(guān)。4..CD34陽性組T-ALL患者的完全緩解率低于CD34陰性組,但差異無統(tǒng)計學(xué)意義,可能與例數(shù)較少有關(guān)。5.未行造血干細胞移植患者中CD34陽性組中位生存期短于CD34陰性組,提示CD34的表達可能是T-ALL的預(yù)后不良因素之一。6.行造血干細胞移植的患者生存率高于未行造血干細胞移植的T-ALL患者,說明造血干細胞移植仍然是急性白血病患者改善預(yù)后的重要治療手段。
[Abstract]:Background and objective Acute T lymphocyte leukemia (acute T-lymphoblastic leukemia-T all) is a disease with high biological heterogeneity. It is more common in children and adolescents, but also in adults, the incidence of which is about 25% of adult ALL. The results showed that CD34 was highly expressed in AML with the exception of AML-M3. The expression of T-ALL was related to the prognosis of ALL. The immunophenotype and clinical characteristics of T-ALL and the relationship between immunophenotype and prognosis were mainly studied by T lymphoid antigens such as CD2T, CD3, CD5, CD5, CD7, and so on. However, for non-specific antigen CD34, the emphasis at home and abroad is on the role of CD34 in hematopoietic stem cell transplantation. The relationship between CD34 and prognosis is reported to be low incidence of CD34, and poor prognosis of CD34 antigen in the expression of CD34 in T-ALL. At present, people do not know enough about its biology, immunology and so on, and can't adjust the treatment plan by identifying reliable prognostic factors. This study analyzed the clinical manifestation and prognosis of CD34 positive and negative adult acute T lymphocyte leukemia patients, and discussed the value of CD34 expression in the prognosis of adult T-ALL. Methods from January 2012 to July 2015, 57 newly diagnosed adult T-ALL patients were analyzed retrospectively. According to the expression of CD34, they were divided into CD34 positive group and CD34 negative group, and the clinical characteristics of the two groups were analyzed. Laboratory examination, the incidence of central nervous system leukemia, the complete remission rate of 4 weeks after chemotherapy and the survival of prognosis were compared. To analyze whether the expression of CD34 affects hematopoietic stem cell transplantation. Results among 57 newly treated adult T-ALL patients, 13 (22.8%) were positive for CD34, 44 (77.2%) were negative for CD34, and 44 (77.2%) were positive for CD34. The complete remission rate of (CR) in sex, age, hepatosplenomegaly, lymphadenopathy, thrombocytopenia, leukocytosis and chromosome abnormality in 4 weeks was found in the positive group and CD34 negative group. In (CNSL) of central nervous system leukemia, there was no significant difference (P0.05) between the expression of CD34 and mediastinal mass (P0.05). The proportion of hemoglobin (Hb) 90 g / L and myeloid antigen expression in the CD34 positive group was higher than that in the negative group at first diagnosis, and the difference was statistically significant (蠂 2 4. 571 P 0. 033; 蠂 2 + 6. 787 P 0. 009). In the course of treatment, 43.2% of the patients had relapsed disease, but there was no correlation between the expression of CD34 and the expression of CD34 (P0.05). The median survival time of CD34 positive group was 5 months and that of CD34 negative group was 17 months. 15 cases of (HSCT) were selected for hematopoietic stem cell transplantation and 42 cases did not choose HSCT.The median survival time of CD34 positive group was 5 months and that of CD34 negative group was 17 months. The difference between the two groups was statistically significant (蠂 2 = 4.220 P < 0.040). Conclusion 1. The expression of CD34 in adult T-ALL was not correlated with age, sex, hepatosplenomegaly, lymphadenopathy, high white blood cell, thrombocytopenia, chromosome abnormality and the incidence of central nervous system leukemia. The complete remission rate of T-ALL patients with positive myeloid antigen expression was lower than that of CD34 negative group, but the difference was not statistically significant, and it might be related to the number of cases. 5. 3. The positive group of disease recurrence was more prone to moderate and severe anemia, and the complete remission rate of T-ALL patients with positive myeloid antigen expression was lower than that of CD34 negative group, but the difference was not statistically significant, and might be related to the number of cases. The median survival time of CD34 positive group was shorter than that of CD34 negative group in patients without hematopoietic stem cell transplantation, suggesting that the expression of CD34 might be one of the poor prognostic factors of T-ALL. The survival rate of patients undergoing hematopoietic stem cell transplantation was higher than that of T-ALL patients without hematopoietic stem cell transplantation, which indicated that hematopoietic stem cell transplantation was still an important therapy for improving the prognosis of patients with acute leukemia.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733.71

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