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目的为了探讨急性淋巴细胞白血病(ALL)各亚型免疫分型的特点及其临床意义。方法采用CD45/SSC双参数散点图设门,应用三色流式细胞术,对81例ALL的初诊患者骨髓标本进行免疫分型,并对其中45例进行核型分析。结果(1)B-ALL中CD19表达最常见(阳性率为100%),而T-ALL中CD5和CD7表达阳性率最高,均为90%;B-ALL和T-ALL都存在抗原交叉表达的现象;两组患者的完全缓解率(CR率)并无显著差异(P>0.05)。(2)伴髓系抗原表达的急性淋巴细胞白血病(My+ALL)比较常见,本组达到39.5%,常累及B淋巴系统(占My+ALL的84.4%);各髓系抗原中以CD13表达阳性率最高;此类患者的CR率较高,儿童CR率为72.2%,成人为78.6%。(3)急性杂合性白血病(HAL)的发病率为19.8%,以髓系、B系共同表达者居多;并且CD34表达阳性率较高(81.3%),该类患者CR率较低(儿童和成人分别为50%和40%)。(4)CD34在B-ALL,My+ALL和HAL中表达阳性率较高,而T-ALL中少见(P<0.025)。结论免疫分型在诊断特殊类型的ALL(如HAL,My+ALL)中具有显著优势;CD19和CD5诊断B-ALL和T-ALL的灵敏度较好,但特异性不高,存在抗原交叉表达;CD34和髓系抗原的表达与CR率无相关性,但在HAL,CD34的表达与CR率成负相关。
Objective To investigate the characteristics and clinical significance of immunophenotyping of subtypes of acute lymphoblastic leukemia (ALL). Methods The CD45 / SSC double-parameter scatter plot was used to set up the gate. Three-color flow cytometry was used to immunophenotype the bone marrow specimens from 81 patients with newly diagnosed ALL. 45 karyotypes were analyzed. Results (1) The expression of CD19 was the most common in B-ALL (positive rate was 100%), while the positive rate of CD5 and CD7 in T-ALL was the highest (90%). Both B-ALL and T- The complete remission rate (CR rate) between the two groups showed no significant difference (P> 0.05). (2) Myeloid antigen-associated acute lymphoblastic leukemia (My + ALL) is more common in this group of 39.5%, often involving the B lymph system (accounting for 84.4% of My + ALL); CD13 expression in each myeloid antigen The highest positive rate was found in these patients. The CR rate was higher in these patients, with a CR rate of 72.2% in children and 78.6% in adults. (3) The incidence of acute heterozygous leukemia (HAL) was 19.8%, most of which were expressed in myeloid and B lines. The positive rate of CD34 expression was higher (81.3%), and the CR rate was lower in these patients And adults were 50% and 40% respectively). (4) The positive rate of CD34 expression in B-ALL, My + ALL and HAL was high, but rare in T-ALL (P <0.025). Conclusion Immunophenotyping has significant advantages in diagnosing special types of ALL (eg, HAL, My + ALL). The sensitivity of CD19 and CD5 in diagnosing B-ALL and T-ALL is good, but their specificity is not high, There was no correlation between the expression of CD34 and myeloid antigens and the CR rate, but at the HAL, the expression of CD34 was negatively correlated with the CR rate.