急性B淋巴细胞白血病患者初发和化疗后微量残留白血病细胞免疫表型的比较

doi:10.3969/j.issn.1673-8640.2016.06.007

摘要/Abstract

摘要：

目的研究急性B淋巴细胞白血病（B-ALL）患者化疗前后白血病细胞免疫表型的改变,为流式细胞术（FCM）检测B-ALL微量残留白血病（MRD）提供理论依据。方法用FCM对比检测226 例B-ALL患者初诊时及化疗后CD45、CD19、CD10、CD20、CD34、CD38、CD13、CD33等抗原表达阳性率及强度的改变。结果抗原表达强度改变的发生概率由高到低依次为CD10、CD34、CD38、CD19、CD20、CD45,CD10明显高于CD38、CD19、CD20和CD45（P<0.01）,CD34明显高于CD19、CD20、CD45（P<0.01）,CD38明显高于CD20、CD45（P<0.01）,CD34、CD45在化疗第33天时表达增强的比例显著高于第15天（P<0.05）。抗原阳性率改变的发生概率由高到低依次为CD20、CD38、CD34、CD45、CD10、CD19,其中CD20和CD38抗原阳性率改变均显著高于CD34、CD45、CD10和CD19（P<0.01）。CD38在化疗第33天时表型消失的比例显著高于第15天（P<0.01）,CD34在化疗第33天时表型出现的比例显著高于第15天（P<0.01）,CD10在第15天时表型消失的比例显著低于第33天和第48天（P<0.05）。大部分患者化疗后发生1~4个抗原表达的改变。结论化疗后B-ALL患者免疫表型表达阳性率及强度改变的概率较高,进行MRD检测时,既应参考患者初诊时免疫表型的特点,又须关注表型的改变。

关键词: 免疫表型, 流式细胞术, 急性B淋巴细胞白血病

Abstract:

Objective To study the change of leukemia immuno-phenotypes before and after chemotherapy in patients with B-lineage acute lymphoblastic leukemia（B-ALL）,and to provide a reference for determining B-ALL minimal residual disease （MRD）by flow cytometry（FCM）. Methods The antigen positive rate and intensity changes of CD45,CD19,CD10,CD20,CD34,CD38,CD13 and CD33 determined by FCM were analyzed before and after chemotherapy among 226 B-ALL patients. Results The intensity changes from high to low were CD10,CD34,CD38,CD19,CD20 and CD45. The intensity changes of CD10 were significantly higher than those of CD38,CD19,CD20 and CD45（P<0.01）,the intensity changes of CD34 were higher than those of CD19,CD20 and CD45（P<0.01）,and the intensity changes of CD38 were higher than those of CD20 and CD45（P<0.01）. In the 33rd day of chemotherapy,the enhanced proportions of CD34 and CD45 expression were higher than those in the 15th day（P<0.05）. The changes of antigen positive rate from high to low were CD20,CD38,CD34,CD45,CD10 and CD19,and those of CD20 and CD38 were significantly higher than those of CD34,CD45,CD10 and CD19（P<0.01）. In the 33rd day of chemotherapy,the loss proportion of CD38 was higher than that in the 15th day（P<0.01）,and the gain proportion of CD34 was significantly higher than that in the 15th day（P<0.01）. In the 15th day, the loss proportion of CD10 was lower than those in the 33rd day and 48th day（P<0.05）. Most patients after chemotherapy had 1-4 antigens' expression changes. Conclusions After chemotherapy,the proportions of antigen positive rate and intensity changes for immuno-phenotypes are high in B-ALL patients. In the determination of MRD,it should consider phenotypes at primary diagnosis and their changes during chemotherapy.

Key words: Immuno-phenotype, Flow cytometry, B-lineage acute lymphoblastic leukemia

中图分类号:

R446.62

王继英, 刘燕, 宋振, 尚磊, 陈雪晶, 周春林, 汝昆, 王慧君. 急性B淋巴细胞白血病患者初发和化疗后微量残留白血病细胞免疫表型的比较[J]. 检验医学, 2016, 31(6): 467-473.

WANG Jiying, LIU Yan, SONG Zhen, SHANG Lei, CHEN Xuejing, ZHOU Chunlin, RU Kun, WANG Huijun. Comparison of minimal residual leukemia immuno-phenotypes at primary diagnosis and after chemotherapy in patients with B-lineage acute lymphoblastic leukemia[J]. Laboratory Medicine, 2016, 31(6): 467-473.

图/表 6

参考文献 25

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免疫表型	表达增强比例			表达减弱比例			表达强度改变比例			总比例
免疫表型	第15天（151例）	第33天（60例）	第48天（51例）	第15天（151例）	第33天（60例）	第48天（51例）	第15天（151例）	第33天（60例）	第48天（51例）	总比例
CD10	19.87	23.33	21.57	9.93	10.00	5.88	29.80	33.33	27.45	30.15
CD34	7.90	23.33	17.65	13.25	3.33	7.84	21.20	26.66	25.49	23.28
CD38	1.32	3.33	1.96	21.19	11.67	13.73	22.51	15.00	15.69	19.47
CD19	13.91	11.67	7.84	3.97	3.33	1.96	17.88	15.00	9.80	15.65
CD20	4.64	1.67	1.96	10.60	6.67	7.84	15.24	8.34	9.80	12.60
CD45	0.00	5.00	3.92	0.00	1.67	0.00	0.00	6.67	3.92	2.29
CD13+CD33^*	9.93	5.00	14.63	7.28	10.00	14.63	17.21	15.00	29.26

免疫表型	表达增强比例			表达减弱比例			表达强度改变比例			总比例
免疫表型	第15天（151例）	第33天（60例）	第48天（51例）	第15天（151例）	第33天（60例）	第48天（51例）	第15天（151例）	第33天（60例）	第48天（51例）	总比例
CD10	19.87	23.33	21.57	9.93	10.00	5.88	29.80	33.33	27.45	30.15
CD34	7.90	23.33	17.65	13.25	3.33	7.84	21.20	26.66	25.49	23.28
CD38	1.32	3.33	1.96	21.19	11.67	13.73	22.51	15.00	15.69	19.47
CD19	13.91	11.67	7.84	3.97	3.33	1.96	17.88	15.00	9.80	15.65
CD20	4.64	1.67	1.96	10.60	6.67	7.84	15.24	8.34	9.80	12.60
CD45	0.00	5.00	3.92	0.00	1.67	0.00	0.00	6.67	3.92	2.29
CD13+CD33^*	9.93	5.00	14.63	7.28	10.00	14.63	17.21	15.00	29.26

免疫表型	表型出现比例			表型消失比例			表型改变比例			总比例
免疫表型	第15天（151例）	第33天（60例）	第48天（51例）	第15天（151例）	第33天（60例）	第48天（51例）	第15天（151例）	第33天（60例）	第48天（51例）	总比例
CD20	7.95	8.33	9.80	26.49	18.33	13.73	34.44	26.66	23.53	30.53
CD38	1.32	0.00	1.96	18.54	41.67	39.22	19.86	41.67	41.18	29.00
CD34	1.99	13.33	3.92	9.93	6.67	0.00	11.92	20.00	3.92	12.21
CD45	7.28	1.67	3.92	5.30	5.00	7.84	12.58	6.67	11.76	11.07
CD10	0.00	1.67	0.00	3.31	13.33	15.69	3.31	15.00	15.69	8.40
CD19	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00
CD13+CD33^*	0.66	2.50	0.00	15.89	22.50	21.39	16.55	25.00	21.39

免疫表型	表型出现比例			表型消失比例			表型改变比例			总比例
免疫表型	第15天（151例）	第33天（60例）	第48天（51例）	第15天（151例）	第33天（60例）	第48天（51例）	第15天（151例）	第33天（60例）	第48天（51例）	总比例
CD20	7.95	8.33	9.80	26.49	18.33	13.73	34.44	26.66	23.53	30.53
CD38	1.32	0.00	1.96	18.54	41.67	39.22	19.86	41.67	41.18	29.00
CD34	1.99	13.33	3.92	9.93	6.67	0.00	11.92	20.00	3.92	12.21
CD45	7.28	1.67	3.92	5.30	5.00	7.84	12.58	6.67	11.76	11.07
CD10	0.00	1.67	0.00	3.31	13.33	15.69	3.31	15.00	15.69	8.40
CD19	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00
CD13+CD33^*	0.66	2.50	0.00	15.89	22.50	21.39	16.55	25.00	21.39