本文關鍵詞：急性髓系白血病免疫表型特征及其臨床意義，由筆耕文化傳播整理發(fā)布。

        目的：探討成人急性髓系白血病細胞免疫表型與預后的關系。方法：148例急性白血病初治患者，其中急性髓系白血�。╝cute myeloid Leukemia,AML）140例，急性混合型白血�。╩ixed aleukemia, MAL）8例。采用流式細胞術方法分析患者的免疫表型。然后按白血病不同類型給予標準誘導緩解方案化療：AML予DA或IA方案（M3除外）；M3采用ATRA或ATRA+As2O3（全反式維甲酸、三氧化二砷）聯(lián)合化療方案；MAL采用TOAP、DOLP方案，并觀察其治療效果。分析比較各免疫表型（CD13、CD33、CD64、CD34、HLA-DR、CD56、CD11b、CD64、CD14等）陽性患者與陰性患者之間的完全緩解率（completeremission）、 AML中伴淋系抗原表達者（Ly+-AML）與無伴淋系抗原表達者（Ly--AML）間的完全緩解率是否存在差異。結果：1．本組148例AML患者中，根據細胞形態(tài)學特征不能分型的6例，經過細胞免疫學檢測，根據其細胞表面或胞漿抗原表達特點得以確診，其中M12例，M54例。另4例形態(tài)學診斷為ALL患者，免疫學分型確診為MAL。其余138例與FAB診斷相符，符合率93.24%。2．148例患者中，有8例MAL，140例AML。AML患者中，M4發(fā)病率最高，其次為M5、M2、M3、M1，而M6發(fā)病率最低。各種抗原表達陽性率由高到低依次為CD38、CD13、CD33、HLA-DR、CD64、CD34、CD11b、CD56、CD14；140例AML中伴淋系表達占49.3%（69例），69例LY+AML中淋系抗原最常見為CD7（43例）、其余依次為CD19（12例），CD4（9例子）、CD2（5例），CD20檢測為陰性。M3中CD34及HLA-DR表達水平明顯低于其他亞型白血病，CD56較常見表達。3．148例AL中，僅95例患者可判斷療效。95例白血病患者經誘導治療后，54例取得完全緩解，總緩解率為56.84%；其中53例AMLCR，CR率57.61%（53/92）；1例MAL CR，CR率33.3%（1/3）。4．AML患者中，淋系免疫表型CD7+CR率明顯低于CD7-患者CR率，兩者間差別具統(tǒng)計學意義（P<0.05）；CD19+CR率高于CD19-CR率，兩者差別具顯著性（P<0.05）。92例AML患者中，Ly+-AML47例，CR率46.81%，Ly--AML42例，CR率68.89%，兩者間差異具統(tǒng)計學意義（P>0.05）。5．CD7、CD19與CD34抗原表達一致性較高，且CD34、CD7雙陽性患者CR率低于CD34+、CD7-患者的CR率，兩者間存在統(tǒng)計學差異；而CD34、CD19雙陽性患者CR率高于CD34+、CD19-患者CR率，差異有統(tǒng)計學意義；CD34、CD11b（成熟粒細胞抗原標志）雙陽性患者CR率明顯低于CD34+、CD11b-患者CR率，且差異有統(tǒng)計學意義；CD56、CD11b雙陽性M5患者CR率低于雙陰性M5患者CR率，但差異無統(tǒng)計學意義。6．祖/干細胞免疫表型CD34+-AML CR率（57.14%）低于CD34--AMLCR率（58.33%），兩者間差別無統(tǒng)計學意義（P>0.05）；HLA-DR+-AMLCR率（57.58%）低于HLA-DR--AMLCR率（57.69%），兩者間差別無統(tǒng)計學意義（P>0.05）；CD38+-AMLCR率（60%）高于CD38--AMLCR率（41.67%），差異無統(tǒng)計學意義。結論：1．免疫表型分析有助于確診一些特殊類型的白血病，在急性白血病的診斷分型中有重要意義；急性髓系白血病CD13、CD33高表達，CD34、HLA-DR表達低下甚至缺如，，尤其非雙陽性患者，可作為M3的較為特異的免疫學表型以協(xié)助診斷。2．AML可以表現為髓系抗原與CD7、CD19等淋系抗原共表達，結果顯示Ly+AML患者的化療療效差；單一非淋系相關抗原的表達對于急性髓系白血病預后判斷的意義仍需進一步探討，而不同抗原異常同步表達（如CD34+CD7+、CD34+CD19+、CD34+CD11b+）對于白血病的預后判斷具一定價值。3．CD56、CD11b作為M5的不良預后因素而有待關注；MAL具有髓系和淋系雙重特征，療效差。

    Objective:To explore the immunophenotyp of leukemia cells and its clinical significance inacute leukemia（AL）patients.Methods:There are148cases of acute leukemia patients, including140cases of acutemyeloid leukemia and8cases of acute mixed leukemia. The immunophenotype of allpatients were analyzed with flow cytometry. Acute myeloid leukemia （non-M3） weretreated with the regimen of DA or IA; M3were treated with ATRA or ATRA+As2O3（all-trans retinoic acid, arsenic trioxide）which combined with chemotherapy; MALwere treated with the regimen of TOAP or DOLP; and then observation of curativeeffect. Analyzing the difference of CR rate between lymphoid antigen positive AMLand lymphoid antigen negative AML, and the difference of CR rate between myeloidantigen positive AL and myeloid antigen negative AL.Results:1. Six cases in the group of148patients, which cann’t typed by the cellmorphology were diagnosed with immunological detection according to the cellsurface or intracellular antigen expression characteristics, including2cases of M1,4cases of M5. It was about93.24%equal with immHnophenotyping-diagnosis andFAB-diagnosis．2. In148patients, there were8cases of mixed leukemia,140patients with AML.In AML patients, M4incidence was the highest, followed by M5, M2, M3, M1, M6andminimum morbidity.In140patients with AML antigen expression from high to low asCD38、CD13, CD33, HLA-DR, CD64, CD34, CD11b, CD56, CD14; lymphoidantigen CD7, CD19,CD4,CD2express in AML, CD20is negative. The expressionlevel of CD34and HLA-DR in M3was significantly lower than the other subtypes ofAML, CD56more common. 3. The CR rate of AML is56.84%（53/93）, the rate of MAL is33.3%（1/3）.4. The CR rate of CD7+-AML was39.28%（11/28）, which was lower than65.63%（42/64） from CD7--AML（P<0.05）. The CR rate of CD19+-AML was91.67%（11/12）, which was higher than52.50%（42/80） from CD19--AML（P<0.05）.And, the CR rate of Ly+AML was46.81%（22/47）,while Ly-AML was68.89%（31/45）,there was statistical significance amony them（P<0.05）.5. CD34, CD7antigen expression of high consistency, and the CR rate in doublepositive patients is lower than the patients with CD34positive and CD7negative,there is significant difference between the two; while the CR rate in CD34, CD19double positive patients is higer than the patients with CD34positive and CD19negative, and the difference was statistically significant; CD34, CD11b doublepositive patients in remission rate higher than that of CD34+, CD11b-patients inremission rate, but the difference was not statistically significant.6. The CR rate of CD34+-AML was57.14%（32/56）, which was lower than58.33%（21/36） from CD34--AML（P>0.05）. The CR rate of HLA-DR+-AML was57.58%（38/66）, which was litter lower than57.69%（15/26） fromHLA-DR--AML（P>0.05）. And, the CR rate of CD38+-AML was60%（48/80）,whileCD38--AML was41.68%（5/12）, there was no statistical significance amonythem（P>0.05）.Conclusion:1.Immunophenotyping of leukemia cells could be helpful for classification ofsome specific type of acute leukemia and has important clinical significant ineva1uating the prognosis of AL.2.The expression of a single antigen for leukemia prognostic significance stillneeds a further study; expression of antigen abnormal synchronization for leukemiamay have some value（CD34+CD7+, CD34+CD19+, CD34+CD11b+）.3.CD56and CD11b have improtant significance in the diagnosis and prognosisof M5; Myeloid antigen and lymphoid antigen are positive in MAL, the curativeeffect of MAL is worse.

        急性髓系白血病免疫表型特征及其臨床意義

中英文縮略詞表4-5中文摘要5-7英文摘要7-8前言9-11材料與方法11-13結果13-20討論20-27結論27-28參考文獻28-30致謝30-31綜述31-46    參考文獻42-46

  本文關鍵詞：急性髓系白血病免疫表型特征及其臨床意義，由筆耕文化傳播整理發(fā)布。