形态学分型困难的白血病24例免疫分型

形态学分型困难的白血病24例免疫分型 作者：孙英慧，马东初，蔺迪，于卉影，时葆赋,陆岩 【关键词】 白血病；免疫分型；流式细胞仪 　　Immunophenotyping in 24 patients with leukemia in comparison with morphotyping 　　【Abstract】 AIM: To study the immunophenotyping with flow cytometry rapidly and efficiently in 24 patients with acute or chronic leukemia. METHODS: Immunophenotyping was performed by doublelabeling with different antibodies conjugated with FITC and PE and analyzed with multiparameter flow cytometry for 24 patients with acute or chronic leukemia, which were difficult to be diagnosed clinically by morphology. RESULTS: ① Nine patients clinically diagnosed as chronic lymphocytic leukemia were immunophenoyped as B lymphocytic leukemia by FCM; ② Five patients clinically diagnosed as acute lymphocytic leukemia (L2) were immunophenotyped as different leukemia groups by FCM, including 1 patient with B lymphocytic leukemia, 2 with T lymphocytic leukemia (one of them with erythrocytic abnormity), 1 with undifferentiated leukemia, and 1 with lymphocytic leukemia expressing both B and T cell antigens; ③ Five patients clinically diagnosed as acute nonlymphocytic leukemia were immunophenotyped by FCM as 2 patients with myeloid leukemia, 3 patients with erythroleukemia (M6); ④ One patient clinically diagnosed as MDS with myelofibrosis was immunophenotyped as M6 by FCM; ⑤ Among 4 patients who were suspected as both myeloid and lymphoidlineage phenotype, only 2 were diagnosed as double myeloid and lymphoid markers positive phenotype. The coincidence between immunophenotype ane FAB phenotype was 79.2%. CONCLUSION: Immunophenotyping by FCM may retrieve the faults of FAB phenotyping, providing important evidences for clinical diagnosis and guiding treatment individually. 　　【Keywords】 leukemia; immunophenotype; flow cytometry 　　【摘要】 目的： 应用流式细胞仪对24例临床形态学诊断困难的急慢性白血病进行快速、有效地免疫分型，以指导临床化疗. 方法： 采用单克隆抗体双色直接免疫荧光标记法及多参数流式细胞术（FCM），分型根据抗体积分系统，并与FAB分型进行比较. 结果： ① 9例临床诊断慢性淋巴细胞白血病经FCM免疫分型确诊为B淋巴细胞性白血病；② 5例临床诊断急性淋巴细胞白血病（L2）的患者经FCM免疫分型确诊1例为B淋巴细胞性白血病；2例为T淋巴细胞性白血病，且1例伴红系异常改变； 1例为未分化型白血病；1例为淋巴细胞白血病B，T双表达；③ 5例急性非淋巴细胞性白血病经FCM免疫分型确诊2例为髓系白血病；3例为红白血病（M6）；④ 1例MDS伴骨髓纤维化经FCM免疫分型确诊为M6；⑤ 4例疑似粒淋双表型白血病经FCM免疫分型确诊为粒淋双表型白血病. 免疫分型与FAB分型的符合率为79.2%. 结论： 流式细胞仪多参数白血病免疫表型分析，可以弥补FAB分型的不足，为临床诊断提供重要依据，并为白血病治疗措施的个体化提供依据. 　　【关键词】 白血病；免疫分型；流式细胞仪 　　0引言 　　白血病是造血系统的恶性肿瘤，在形态上变化虽相当大，但仍能表达正常血细胞所具有的抗原，因而可依据其抗原的表达谱对白血病进行免疫分型. 我们对24例临床确诊为急慢性白血病，但形态学分型较困难的患者，应用流式细胞仪对其进行了免疫分型，并与FAB分型进行了比较. 　　1材料和方法 　　1.1材料白血病患者的骨髓24（男11，女13）例，年龄17～67（平均44）岁. 所用单抗包括FITC标记的