62例急性白血病流式細胞儀免疫分型的特點及預后分析

陳瑛 陳海娟 王萍

[摘要] 目的 探討流式細胞儀免疫分型在急性白血病（AL）患者中的表達特點、診斷價值及其預后意義，為建立個體化的治療提供指導。 方法 回顧性對我院收治的62例初發AL患者的骨髓細胞形態學、流式細胞儀免疫分型檢測結果進行對比分析，了解二者診斷相符率。結合細胞遺傳學及分子生物學檢查結果進行預后分析，之后分組觀察患者治療反應及生存情況。 結果 5例急性白血病患者通過骨髓細胞形態學和組織化學檢查未能明確分型診斷，經流式細胞儀免疫分型檢測后確定。2例骨髓細胞形態與流式細胞儀免疫分型結果不符，結合細胞遺傳學特點，予以修正診斷。AML及ALL均存在跨系表達抗原，AML常見的跨系抗原表達為CD56、CD7、CD19。ALL常見跨系抗原表達為CD13、CD15、CD33。部分分子遺傳學異?？蓪挟惓？乖磉_，AML中CD7表達常伴有FLT3/ITD突變。AML伴t（8;21）（q22;q22）/AML1-ETO陽性患者中，60%左右表達CD19。在療效觀察中發現伴有預后不良染色體核型或分子遺傳學標志的老年性急性髄系白血病患者（年齡≥70歲）中，非化療組總生存期（OS）與化療組相比無差異性（P>0.05）。 結論 流式細胞儀免疫分型檢測可以提高急性白血病分型診斷的準確性，結合細胞遺傳學和分子生物學可有效地指導臨床制定治療方案和預后判斷。

[關鍵詞] 急性白血病;流式細胞術;免疫表型;預后分析

[Abstract] Objective To investigate the expression characteristics， diagnostic value and prognostic significance of flow cytometry immunophenotyping in patients with acute leukemia（AL）， and to provide guidance for the establishment of individualized treatment. Methods The bone marrow morphological and flow cytometry immunophenotyping results of 62 patients with initial AL admitted in our hospital were retrospectively analyzed to understand the diagnostic coincidence rate. The prognostic analysis was performed by combining the results of cytogenetics with molecular biology examination. And then the treatment response and survival of the patients were observed in groups. Results Five patients with acute leukemia were not diagnosed by bone marrow cell morphology and histochemical examination， and were identified by flow cytometry immunophenotyping. The morphology of 2 cases bone marrow cells was inconsistent with the results of flow cytometry immunophenotyping， and combined with cytogenetic characteristics， the diagnosis was corrected. Both AML and ALL had cross-line expression antigens， and common cross-line antigens of AML expressed were CD56， CD7 and CD19. The common cross-line antigens ALL expressed were CD13， CD15， CD33. Some molecular genetic abnormalities may correspond to abnormal antigen expression， and CD7 expression in AML was often accompanied by FLT3/ITD mutation. In AML patients with t（8;21）（q22;q22）/AML1-ETO positive， about 60% expressed CD19. In the efficacy observation， it was found that there was no significant difference in overall survival （OS） between the non-chemotherapy group and the chemotherapy group in the elderly patients with acute sputum leukemia （age≥70 years） with poor prognosis karyotype or molecular genetic markers（P>0.05）. Conclusion Flow cytometry immunophenotyping can improve the accuracy of acute leukemia typing diagnosis， which can effectively guide clinical planning and prognosis combined with cytogenetics and molecular biology.