摘要
目的：评估流式细胞仪细胞免疫表型检测（FCI）在慢性粒单核细胞白血病（CMML）诊断和监测治疗反应中的临床价值和意义。方法采用多色 FCI 分析法和形态学观察法对109例 CMML 患者和39例随访患者的骨髓标本的免疫表型和形态学进行检测和评价，并对结果进行统计学分析。结果采用 FCI 测得骨髓单核细胞百分比为15％。与形态学分出的单核细胞百分比相关（r ＝0．35，P＝0．0003）。96％患者单核细胞 FCI 发生改变；FCI 观察到的 CMML 粒细胞生成障碍为91．7％明显高于形态学方法测得的82．6％（χ2＝4．10，P＜0．05）。 CMML 患者 FCI CD34＋细胞测定结果为中位数0．7％（范围0．15％～11．60％），但其免疫表型改变非常显著改变个数的中位数为7（范围1～11个）。91％患者出现1阶段原始血细胞缺失或明显减少。39例随访患者中35例使用低甲基化剂（HMA）治疗和4例等待治疗患者的骨髓样品 CD34＋原始细胞均被检测到持续的免疫表型改变，对 HMA 治疗有应答的13例患者单核细胞 CD14表达均正常；而40．9％（9／22）HMA 治疗无应答者单核细胞 CD14表达发生改变（P＝0．030），4例接受造血干细胞移植治疗的患者免疫表型于移植后均正常。结论 CMML 患者的 CD34＋细胞，单核细胞和粒细胞表现出多种 FCI 异常，FCI 能够将恶性增生从反应性单核细胞增多中区分出来，同时也可用于监测 CMML 患者治疗反应。
Objective To evaluate the clinical value and significance of flow cytometry immunophenotypic（FCI） detection in the diagnosis of chronic myelomonocytic leukemia（CMML） and monitoring of the treatment response .Methods The multicolor FCI as‐say and morphology observation method were adopted to detect and evaluate the immunophenotype and morphology of bone marrow （BM ） samples in 109 patients with CMML and 39 follow‐up patients .The results were statistically analyzed .Results The BM monocytes percentage detected by FCI was 15% ,which was correlated with morphologic monocytes percentage （r = 0 .35 ,P =0 .000 3） .The monocyte FCI in 96% patients had changes ;the granulocytes dyspoiesis of CMML was 91 .7% observed by FCI , which was significantly higher than 82 .6% by morphology （χ2 = 4 .10 ,P 〈 0 .05） .The FCI detection results of CD34 ＋ cells in CMML patients was mean 0 .7% （ranged 0 .15% - 11 .60% ） ,but their FCI changes were very significant[median 7（1 - 11）] .91%patients appeared the primitive blood cells deletion or significant reduce in the first stage .Among 39 follow‐up patients ,the continu‐ous FCI changes were detected in the CD34 ＋ primitive cells of the BM samples in 35 patients with HMA therapy and 4 cases of waiting therapy ,13 cases of HMA therapeutic response had normal expression of monocyte CD14 ,while 40 .9% （9/22） patients without HMA therapeutic response had the monocyte CD14 expression changes （ P = 0 .030） ,4 patients receiving hematopoietic stern cell transplant had normal FCI after transplant .Conclusion CD34 ＋ cells ,monocytes and granulocytes in CMML patients manifest multiple FCI abnormality ;FCI can differentiate the malignant hyperplasia from the reactive monocytosis ,meanwhile can be used for monitoring the therapeutic response of CMML patients .
出处
《检验医学与临床》
CAS
2016年第18期2595-2598,2601,共5页
Laboratory Medicine and Clinic
关键词
慢性粒单核细胞白血病
流式细胞免疫分型
低甲基化剂
chronic myelomonocytic leukemia
flow cytometric immunophenotyping
hypomethylating agent
