变异性急性早幼粒细胞白血病实验室检查结果分析

doi:10.3969/j.issn.1673-8640.2019.10.001

摘要/Abstract

摘要： 目的了解伴CD14、CD7高表达的变异性急性早幼粒细胞白血病（APL）形态学改变情况及相关实验室检查结果,提高对APL的诊断正确率。方法收集伴CD14、CD7高表达的APL患者的所有临床资料及实验室检查结果并进行分析。结果 APL患者细胞形态学与急性髓系白血病（AML）-M5有相似之处,核扭曲折叠比较明显,胞浆中颗粒细小,双核异常早幼粒细胞多见。免疫抗原：常规表达CD13、CD33、CD117和细胞质髓过氧化物酶（cMPO）,高表达CD14、CD7。白血病基因定性筛查：PML-RARα融合基因为阳性,NPM-MLF1融合基因为可疑阳性。结论 APL易与AML-M2、AML-M5混肴。有些APL细胞形态较规则,似AML-M2,可通过PML-RARα融合基因阳性、细胞遗传学t（15;17）（q22;q21）易位排除AML-M2;有些APL细胞形态扭曲,折叠明显,胞质中颗粒细小,似AML-M5,可通过细胞化学染色（过氧化物酶强阳性、特异性酯酶阳性）排除AML-M5。综合临床及实验室检查结果可对APL作出诊断,伴有相关抗原表达以及变异性融合基因不影响对APL的诊断。

关键词: 急性早幼粒细胞白血病, 变异性, 免疫抗原, CD14, CD7, 融合基因

Abstract: Objective To investigate the morphological changes and related laboratory examination of variability acute promyelocytic leukemia（APL） with high expressions of CD14 and CD7,and to improve the accuracy of variability APL and reduce misdiagnosis. Methods All clinical data and the results of laboratory examination were collected. Results The morphology of this patient was similar to that of acute myelocytic leukemia（AML）-M5. The nuclear distortion was obvious. The cytoplasm had fine particles. The binuclear abnormal promyelocytic cells were common. Immunological antibodies routinely expressed CD13,CD33,CD117 and cytoplasm myeloperoxidase（cMPO）,accompanied by high expressions of CD14 and CD7. Qualitative screening of leukemia genes showed that PML-RARα fusion gene was positive,but NPM-MLF1 fusion gene was suspected positive. Conclusions APL is easy to mix with AML-M2 and AML-M5. Its morphology is similar to AML-M2. AML-M2 can be excluded by PML-RARαfusion gene-positive,cytogenetic t（15;17）（q22;q21） translocation. Some cell morphology is distorted and folded,and the cytoplasm has fine particles,which is similar to AML-M5. AML-M5 can be excluded by histochemical staining for peroxidase-positive and specific lipase-positive. It should synthesize clinical and laboratory examination to diagnose APL,and the diagnosis of APL is not affected by the expression of related antigens and the mutated fusion gene.

Key words: Acute promyelocytic leukemia, Variability, Immunological antibody, CD14, CD7, Fusion gene

中图分类号:

R446.1

张校辉, 邢江涛, 张玉娜, 李建英, 苗蕊, 胡蕊, 朱芸. 变异性急性早幼粒细胞白血病实验室检查结果分析[J]. 检验医学, 2019, 34(10): 871-875.

ZHANG Xiaohui, XING Jiangtao, ZHANG Yuna, LI Jianying, MIAO Rui, HU Rui, ZHU Yun. Laboratory examination analysis of 1 case of variability acute promyelocytic leukemia[J]. Laboratory Medicine, 2019, 34(10): 871-875.

图/表 6

图1 异常早幼粒细胞（瑞-吉染色,×1 000）

图2 POX（×1 000）

图3 AS-DNCE（×1 000）

图4 α-NBE（×1 000）

图5 CD14流式细胞图

图6 CD7流式细胞图

参考文献 28

[1]	李军民,任雨虹. 急性早幼粒细胞白血病出血并发症的机制及治疗进展[J]. 临床血液学杂志,2015,28(2):190-193.
[2]	ZHANG L,SAMAD A,POMBO-DE-OLIVEIRA M S,et al. Global characteristics of childhood acute promyelocytic leukemia[J]. Blood Rev,2015,29(2):101-125.
[3]	常子维,李秋红,朱华锋,等. 一例少见原始细胞伴有Auer存在的变异型急性早幼粒细胞白血病病例报道[J]. 现代生物医学进展,2016,16(34):6679-6683.
[4]	陈燕,李晓明,邢宏运,等. 1例伴孤立性i(17)(q10)染色体异常的急性早幼粒细胞白血病[J]. 检验医学与临床,2017,14(4):596-598.
[5]	IMATAKI O,UEMURA M.Chromosomal abnormality of acute promyelocytic leukemia other than PML-RARA:a case report of acute promyelocytic leukemia with del(5q)[J]. BMC Clin Pathol,2016,16:16.
[6]	ZHANG X,PAN J.A novel clonal t(1;4)(p36.1;q31) translocation in acute promyelocytic leukaemia[J]. J Clin Pathol,2015,68(5):391-393.
[7]	中华医学会血液学分会,中国医师协会血液科医师分会. 《中国急性早幼粒细胞白血病诊疗指南(2018年版)》[J]. 中华血液学杂志,2018,39(3):179-183.
[8]	高旭红,徐丹,李蓉. CD64联合CD14检测在急性髓系白血病免疫分型鉴别中的应用价值[J]. 临床医学,2018,38(4):56-58.
[9]	卢业健,邱兰兰,王莉莉. CD7在非M3急性髓系白血病中表达及其意义[J]. 临床军医杂志,2017,45(4):353-356.
[10]	薛白,李靖,王奔放. 急性早幼粒细胞白血病实验室诊断方法研究进展[J]. 实验与检验医学,2016,34(1):44-47.
[11]	连芸,黄佳瑜,张晶晶,等. 老年急性髓系白血病基因突变及临床意义[J]. 临床血液学杂志,2018,31(1):14-18.
[12]	董婷,蒋雅先,李正发,等. 急性早幼粒细胞白血病的细胞表面免疫分子的检测和分析[J]. 细胞与分子免疫学杂志,2017,33( 5):664-667.
[13]	BRECCIA M,DE PROPRIS M S,MINOTTI C,et al. Aberrant phenotypic expression of CD15 and CD56 identifies poor prognostic acute promyelocytic leukemia patients[J]. Leuk Res,2014,38(2):194-197.
[14]	XU S,LI X,ZHANG J,et al.Prognostic value of CD56 in patients with acute myeloid leukemia:a meta-analysis[J]. J Cancer Res Clin Oncol,2015,141( 10):1859-1870.
[15]	卢兴国. 骨髓细胞学和病理学[M]. 北京:科学出版社,2008:269-270.
[16]	姚尔固,林凤茹,郭晓楠,等. 恶性血液病诊治和疗效标准[M]. 2版. 北京:人民军医出版社,2009:193-200.
[17]	TSAI C H,HOU H A,TANG J L,et al.Genetic alterations and their clinical implications in older patients with acute myeloid leukemia[J]. Leukemia,2016,30(7):1485-1492.
[18]	OSTRONOFF F,OTHUS M,LAZENBY M,et al.Prognostic significance of NPM1 mutations in the absence of FLT3-internal tandem duplication in older patients with acute myeloid leukemia:a SWOG and UK National Cancer Research Institute/Medical Research Council report[J]. J Clin Oncol,2015,33(10):1157-1164.
[19]	王亚哲,秦亚溱,江滨,等. 221例急性早幼粒细胞白血病免疫表型特点与微小残留病检测及基因标志的关系[J]. 中国实验血液学杂志,2009,17(2):271-276.
[20]	陈芳,胡延平,王孝会,等. 急性早幼粒细胞白血病免疫表型特点[J]. 中国实验血液学杂志,2016,24( 2):321-325.
[21]	宋梅,吴秀梅,张梅,等. 白血病细胞早幼粒细胞白血病(PML)蛋白存在形式的检测和临床意义[J]. 细胞与分子免疫学杂志,2017,33(7):971-976.
[22]	AMBAYYA A,ZAININA S,SALMIAH M S,et al.Antigen expression pattern of acute promyelocytic leukaemia cases in malaysia[J]. Med J Malaysia,2014,69(2):64-69.
[23]	莫扬,李智山. 急性白血病免疫表型及阳性细胞比例分析[J]. 检验医学,2012,27(6):431-435.
[24]	KUTNY M A,GREGORY J Jr,FEUSNER J H.Treatment of paediatric APL:how does the therapeutic approach differ from adults?[J]. Best Pract Res Clin Haematol,2014,27(1):69-78.
[25]	BRECCIA M,COCO F L.Thrombo-hemorrhagic deaths in acute promyelocytic leukemia[J]. Thromb Res,2014,133:S112-S116.
[26]	HE B,HU S,QIU G,et al.Clinical characteristics of acute promyelocytic leukemia manifesting as early death[J]. Mol Clin Oncol,2013,1(5):908-910.
[27]	YIN C C,JAIN N,MEHROTRA M,et al.Identification of a novel fusion gene,IRF2BP2-RARA,in acute promyelocytic leukemia[J]. J Natl Compr Canc Netw,2015,13(1):19-22.
[28]	黄静沁,许闪闪,李智,等. 白血病诊断综合分析的重要意义[J]. 检验医学,2014,29(11):1158-1163.