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目的 :分析慢性粒-单核细胞白血病(chronic myelomonocytic leukemia,CMML)的细胞形态学特点,为对照,探索免疫标记物在CMML诊断中的意义及临床应用价值。方法:采用骨髓活检病理组织学方法分析39例CMML的病理学特点;采用免疫组化法,以CMML为实验组,慢性粒细胞白血病(chronic myelocytic leukemia,CML)及急性单核细胞白血病(acute monocytic leukemia,AMo L)为对照组,检测CD15、MPO、CD34、CD14、CD56、CD68(PG-M1)、CD163在上述3组中的表达。结果 :CMML骨髓病理组织学提示33例(84.6%)骨髓增生极度活跃,粒系细胞增生明显且形态异常,29例(74.4%)单核细胞增多,20例(51.3%)巨核细胞形态异常。粒细胞标记物CD15、MPO在CMML中的阳性表达率分别为(21.69±7.06)%,(33.96±5.94)%,其与CML及AMo L均有统计学差异。单核细胞标记物CD14、CD56、CD68(PG-M1)及CD163的阳性表达率分别为(10.10±2.51)%、(8.69±2.66)%、(13.35±4.32)%、(11.43±4.15)%,除CD56外,其余在CMML与AMo L的阳性率均有明显差异。原始细胞标记物CD34的阳性表达率为4.31±1.98%,与CML有统计学差异。结论:骨髓病理组织学及免疫组化有助于CMML的诊断及鉴别诊断。
OBJECTIVE: To analyze the cell morphological characteristics of chronic myelomonocytic leukemia (CMML) as a control and to explore the significance and clinical value of immunological markers in the diagnosis of CMML. Methods: Pathological features of 39 cases of CMML were analyzed by bone marrow biopsy. Immunohistochemistry, CMML as experimental group, chronic myelocytic leukemia (CML) and acute monocytic leukemia, AMo L) were used as controls to detect the expression of CD15, MPO, CD34, CD14, CD56, CD68 (PG-M1) and CD163 in the above three groups. Results: Thirty-three cases (84.6%) had myeloproliferative hyperplasia. The myelocytic hyperplasia was obvious and abnormal. The mononuclear cells increased in 29 cases (74.4%) and the abnormal morphology in 20 cases (51.3%). The positive rates of granulocyte marker CD15 and MPO in CMML were (21.69 ± 7.06)% and (33.96 ± 5.94)%, respectively, which were significantly different from those of CML and AMoL. The positive rates of monocyte markers CD14, CD56, CD68 and CD163 were (10.10 ± 2.51)%, (8.69 ± 2.66)%, (13.35 ± 4.32)% and (11.43 ± 4.15)%, respectively , Except for CD56, the other positive rates of CMML and AMo L were significantly different. The positive rate of CD34 was 4.31 ± 1.98%, which was significantly different from that of CML. Conclusion: Bone marrow histopathology and immunohistochemistry contribute to the diagnosis and differential diagnosis of CMML.