【摘要】：目的:探討急性B淋巴細(xì)胞白血病(B-ALL)免疫表型表達(dá)特征及臨床意義。方法:采用流式細(xì)胞術(shù)(FMC)對(duì)初診的50例BCR-ABL融合基因陰性的急性B淋巴細(xì)胞白血病患者進(jìn)行免疫分型。觀察急性B淋巴細(xì)胞白血病的免疫表型表達(dá)特征及臨床意義。結(jié)果:50例患者中,B細(xì)胞抗原中CD19+表達(dá)率為84.00%,陽(yáng)性表達(dá)率最高。T細(xì)胞抗原CD5、CD7可跨系表達(dá)。伴髓系抗原中CD13+表達(dá)率最高,表達(dá)率為48.00%。50例患者入院確診后均進(jìn)行誘導(dǎo)化療,第一次化療后完全緩解(CR1)率為76.00%,總有效率為86.00%。男性患者第一次化療后CR1率為77.27%,總有效率為95.45%,女性CR1率及總有效率分別為75.00%、78.57%,男女兩組CR1率、總有效率比較不具備統(tǒng)計(jì)學(xué)差別。依據(jù)年齡分為≥40歲和40歲兩組,第一次化療后≥40歲組CR1率為57.14%,總有效率71.42%,40歲組CR1率為89.65%,總有效率為96.55%,≥40歲組CR1率、總有效率均低于40歲組,比較具備統(tǒng)計(jì)學(xué)差別。依據(jù)貧血嚴(yán)重程度可以將所有患者分成輕度貧血組和中重度貧血組,首次化療后輕度貧血組CR1率為100%,總有效率100%,中重度貧血組CR1率為62.50%,總有效率為78.12%,兩組之間CR1率、總有效率分別比較,輕度貧血組都高于中重度貧血組,具備統(tǒng)計(jì)學(xué)差別。29例CD10+組患者首次化療后CR1率為86.20%,總有效率為96.55%,21例CD10-組CR1率為61.90%,總有效率71.42%,CD10-組完全緩解率、總有效率都低于CD10+組,具備統(tǒng)計(jì)學(xué)差異。26例CD20+組患者首次化療后CR1率為57.69%,總有效率為73.08%,24例CD20-組患者第一次化療后完全緩解率為95.83%,總有效率100%,CD20-組的CR1率、總有效率都高于CD20+組,具備統(tǒng)計(jì)學(xué)意義。24例CD13+組患者首次化療后CR1率為62.50%,總有效率為70.83%,26例CD13-組患者CR率為88.46%,總有效率100%,CD13+組完全緩解率、總有效率均低于CD13-組,統(tǒng)計(jì)學(xué)比較存在差異。11例CD33+組患者首次化療后CR1率為45.45%,總有效率為54.54%,37例CD33-組患者CR1率為86.48%,總有效率94.59%,CD33+組完全緩解率、總有效率均低于CD33-組,統(tǒng)計(jì)學(xué)比較有差異。25例CD34+組患者首次化療后CR1率為64.00%,總有效率為72.00%,20例CD34-組患者CR1率為95.00%,總有效率100%,CD34+組完全緩解率、總有效率均低于CD34-組,統(tǒng)計(jì)學(xué)比較有差異。15例CD96+組患者首次化療后CR1率為46.66%,總有效率為60.00%,16例CD96-組患者CR1率為87.50%,總有效率93.75%,CD96-組的CR1率、總有效率均高于CD96+組,具備統(tǒng)計(jì)學(xué)差別。29例My+B-ALL組患者中有首次化療后CR1率為65.51%,總有效率為75.86%,21例My-B-ALL組患者中首次化療后CR1率為90.47%,總有效率100%,My-B-ALL組CR1率、總有效率兩者都高于My+B-ALL組,統(tǒng)計(jì)學(xué)比較有差異。CD34/CD13抗原共表達(dá)組占總例數(shù)的20.00%,CD34/CD33共表達(dá)組占總例數(shù)的14.00%,CD34/CD96共表達(dá)組占總例數(shù)的18.00%。CD34/CD13抗原共表達(dá)組和非共表達(dá)組的CR1率分別是30.00%,86.20%,其總有效率分別是30.00%,100%。CD34/CD33抗原共表達(dá)組和非共表達(dá)組的CR1率分別是28.57%,77.27%,其總有效率分別是28.57%,90.90%。CD34/CD96抗原共表達(dá)組和非共表達(dá)組的CR1率分別是22.22%,86.36%,其總有效率分別是33.33%,95.45%。CD34/CD13抗原共表達(dá)組CR1率、總有效率均明顯低于CD34/CD13非共表達(dá)組,具備顯著統(tǒng)計(jì)學(xué)意義。CD34/CD33共表達(dá)組的CR1率、總有效率均低于CD34/CD33非共表達(dá)組,具備統(tǒng)計(jì)學(xué)意義。CD34/CD96共表達(dá)組的CR1率、總有效率均低于CD34/CD96非共表達(dá)組,具備統(tǒng)計(jì)學(xué)意義。結(jié)論:1.CD19是B-ALL的敏感性、特異性抗原;CD7、CD5可跨系表達(dá)于B-ALL;B-ALL伴髓系抗原中CD13陽(yáng)性率最高。2.性別對(duì)B-ALL臨床療效無(wú)影響;年齡是影響B(tài)-ALL臨床療效的因素;初診時(shí)貧血嚴(yán)重程度是影響B(tài)-ALL臨床療效的因素。3.CD10+與B-ALL臨床療效呈正相關(guān),免疫表型CD20+、CD13+、CD33+、CD34+、CD96+均與B-ALL臨床療效呈負(fù)相關(guān)。4.My+B-ALL臨床療效差;抗原CD34/CD13、CD34/CD33、CD34/CD96共表達(dá)與B-ALL臨床療效呈負(fù)相關(guān)。
[Abstract]:Objective: To investigate the immunophenotypic characteristics and clinical significance of acute B-lymphoblastic leukemia (B-ALL). Methods: Immunophenotyping of 50 newly diagnosed patients with BCR-ABL fusion gene negative acute B-lymphoblastic leukemia was performed by flow cytometry (FMC). Results: The expression rate of CD19+ in B cell antigen was 84.00% and the positive rate was the highest. T cell antigen CD5 and CD7 could be expressed across lines. The expression rate of CD13+ in myeloid antigen was the highest (48.00%). After the first chemotherapy, the CR1 rate was 77.27%, the total effective rate was 95.45%, the female CR1 rate and the total effective rate were 75.00% and 78.57%, respectively. According to the severity of anemia, all patients can be divided into mild anemia group and moderate and severe anemia group. After the first chemotherapy, the CR1 rate of mild anemia group is 100%, the total effective rate is 100%, and the CR1 rate of moderate and severe anemia group is 62.50%. The total effective rate was 96.55%. The CR1 rate was 61.90%. The total effective rate was 71.42%. The total effective rate of CD10-group was lower than that of CD10+group. The total effective rate was 73.08%. The total effective rate was 95.83%. The total effective rate was 100%. The total effective rate was higher in the CD20 group than that in the CD20 + group. The total effective rate was 62.50% in the CD13 + group. The total effective rate was 100%. The total effective rate of CD13 + group was lower than that of CD13 - group. The total effective rate was 45.45%. The total effective rate was 54.54%. The total effective rate was 86.48%. The total effective rate was 94.59%. The total effective rate of CD33 + group was lower than that of CD13 - group. The CR1 rate was 64.00%, the total effective rate was 72.00%, the CR1 rate was 95.00%, the total effective rate was 100%, the total effective rate was 100%, and the total effective rate was lower in the CD34 + group than in the CD34 - group. The CR1 rate in the CD96 + group was 46.6% after the first chemotherapy. The total effective rate was 60.00%. The total effective rate was 87.50% and 93.75% in 16 patients with CD96-group. The total effective rate of CD96-group was higher than that of CD96+group. The total effective rate was 65.51% and 75.86% in 29 patients with My+B-ALL after the first chemotherapy. The total effective rate was 90.47% and 1.47% in 21 patients with My-B-ALL after the first chemotherapy. The CR1 rate and total effective rate in my-B-ALL group and my-B-ALL group were higher than those in my+B-ALL group. The CR1 rate of CD34/CD13 antigen co-expression group accounted for 20.00%, CD34/CD33 co-expression group accounted for 14.00%, CD34/CD96 co-expression group accounted for 18.00% and CD34/CD96 co-expression group accounted for 30.00% and 86.20% respectively. The total effective rates were 30.00% and 100%, respectively. The CR1 rates of CD34/CD33 co-expression group and non-co-expression group were 28.57% and 77.27%, respectively. The total effective rates were 28.57% and 90.90% respectively. The CR1 rates of CD34/CD96 co-expression group and non-co-expression group were 22.22% and 86.36% respectively. The total effective rates were 33.33% and 95.45% respectively. The total effective rate of the CD34/CD33 co-expression group was lower than that of the CD34/CD13 non-co-expression group. The total effective rate of the CD34/CD33 co-expression group was lower than that of the CD34/CD33 non-co-expression group. The total effective rate of the CD34/CD96 co-expression group was lower than that of the CD34/CD96 non-co-expression group. CD7 and CD5 can be expressed in B-ALL; CD13 positive rate is the highest in B-ALL with myeloid antigen. 2. Gender has no effect on clinical efficacy of B-ALL; age is the factor affecting clinical efficacy of B-ALL; anemia severity is the factor affecting clinical efficacy of B-ALL at initial diagnosis. 3. CD10 + is positively correlated with clinical efficacy of B-ALL, and immunophenotype is the highest. CD20 +, CD13 +, CD33 +, CD34 +, CD96 + were negatively correlated with the clinical efficacy of B-ALL. 4. My + B-ALL had poor clinical efficacy; the co-expression of antigen CD34/CD13, CD34/CD33, CD34/CD96 was negatively correlated with the clinical efficacy of B-ALL.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R733.71

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