摘要目的 探讨初治急性髓细胞白血病(AML)成年患者的免疫表型特征及其与疗效的关系.方法 采用计算机生成随机数法选择2013年1月至2016年12月山东省淄博市中心医院收治的167例初治AML成年患者为研究对象.采用单克隆抗体直接免疫荧光标记法对患者的AML细胞抗原进行标记.采用三色流式细胞术CD45/侧向散射光(SSC)双参数散点图设门法,分别对患者AML细胞的髓细胞系、淋巴细胞系及造血干/祖细胞相关抗原进行免疫表型分析.所有AML患者均接受常规诱导化疗方案治疗,化疗1个疗程后,观察其是否获得完全缓解(CR).采用x2检验,比较不同免疫表型AML患者的CR率.本研究遵循的程序符合淄博市中心医院人体试验委员会所制定的伦理学标准,得到该委员会批准(批准文号:院发[2013]9号),并与所有受试者签署临床知情同意书.结果 ①本研究167例初治AML成年患者的髓细胞系相关抗原表达阳性率由高到低的抗原依次为:CD33 (90.4％,151/167),CD13 (87.4％,146/167),CD117(79.0％,132/167),髓过氧化物酶(MPO) (71.3％,119/167),CD64 (31.7％,53/167),CD14(21.6％,36/167)及CD71(4.2％,7/167).33例AML-M4和40例AML-M5亚型患者的CD14和CD64表达阳性率较高,CD14表达阳性率分别为24.2％(8/33)和62,5％(25/40),CD64表达阳性率分别为48.5％(16/33)和77.5％(31/40).5例AML-M6亚型患者的CD71表达均呈阳性.②167例初治AML成年患者的造血干/祖细胞相关抗原CD38表达阳性率最高,为89.8％(150/167),CD34和人类白细胞抗原(H LA)-DR表达阳性率相近,分别为57.5％(96/167)和58.7％ (98/167).34例AML-M3亚型患者的CD34和HLA-DR表达阳性率较低,分别为5.9％(2/34)和8.8％(3/34).③167例初治AML成年患者的淋巴细胞系相关抗原表达阳性率由高到低的抗原依次为:CD7 (20.4％,34/167),CD19(13.8％,23/167),CD4(7.2％,12/167),CD2 (4.2％,7/167),CD10 (1.8％,3/167),CD22 (1.2％,2/167)及CD20(0.6％,1/167).④167例初治AML成年患者接受首次诱导化疗后,达到CR者为103例,CR率为61.7％.133例非AML-M3亚型患者中,CD7、CD34表达呈阳性AML患者的CR率分别为51.5％(17/33)和45.7％(43/94),均低于阴性者的72.0％(72/100)和69.2％(27/39),并且差异均有统计学意义(x2=4.703,P=0.030;x2=6.099,P=0.014);MPO、CD19表达呈阳性AML患者的CR率分别为71.3％(62/87)和69.6％(16/23),均高于阴性者的47.8％(22/46)和46.4％(51/110),并且差异均有统计学意义(x2=7.104,P=0.008;x2=4.096,P=0.043).结论 CD33、CD13、CD117及MPO为初治AML成年患者常见的免疫标志物.CD7、CD34表达呈阳性的初治AML成年患者的首次诱导化疗后CR率低于阴性者,而MPO、CD19表达呈阳性的初治AML成年患者的首次诱导化疗后CR率高于阴性者.免疫分型对于初治AML成年患者的诊断分型,以及预后判断具有重要意义.

abstractsObjective To investigate the immunophenotypic characteristics of adult patients with initial treatment of acute myeloid leukemia (AML),as well as its relationship with curative effect.Methods A total of 167 adult patients with initial treatment of AML were randomly selected by computer generated random number method from January 2013 to December 2016 in Zibo Central Hospital of Shandong Province.Monoclonal antibody direct immunofluorescence labeling was used to label AML cell antigens of patients.The immunophenotypes of myeloid cell lines,lymphoid cell lines,and hematopoietic stem/progenitor cells of patients' AML cells were analyzed by tricolor flow cytometry two-parameter scatter plot with CD45/side scatter (SSC).All AML patients were treated with conventional induction chemotherapy.After 1 course of chemotherapy,complete remission (CR) rates of patients were observed.The CR rates of AML patients of different immunophenotype were compared using x2 test.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Zibo Central Hospital (Approval No.2013-9).Informed consent was obtained from each participant.Results ① Among 167 adult patients with initial treatment of AML in this study,myeloid cell lines related antigens of positive expression rates from high to low were as follows:CD33 (90.4％,151/167),CD13 (87.4％,146/167),CD117 (79.0％,132/167),myeloperoxidase (MPO) (71.3％,119/167),CD64 (31.7％,53/167),CD14 (21.6％,36/167) and CD71 (4.2％,7/167).The positive expression rates of CD14 and CD64 in 33 AML-M4 patients and 40 AML-M5 patients were high.The positive expression rates of CD14 and CD64 in AML-M4 patients were 24.2％ (8/33) and 48.5％ (16/33),respectively.And the positive expression rates of CD14 and CD64 in AML-M5 patients were 62.5％ (25/40) and 77.5％ (31/40),respectively.CD71 expressions were all positive in 5 AML-M6 patients.② The hematopoietic stem/progenitor cells related antigens of positive expression rates from high to low in 167 adult patients with initial treatment of AML were as follows:CD38 (89.8％,150/167),human leukocyte antigen (HLA)-DR (58.7％,98/167),and CD34 (57.5％,96/167).The positive expression rates of CD34 and HLA-DR were low in 34 AML-M3 patients,which were 5.9％ (2/34) and 8.8％ (3/34),respectively.③ The lymphoid cell lines related antigens of positive expression rates from high to low in 167 adult patients with initial treatment of AML were as follows:CD7 (20.4％,34/167),CD19 (13.8％,23/167),CD4 (7.2％,12/167),CD2 (4.2％,7/167),CD10 (1.8％,3/167),CD22 (1.2％,2/167) and CD20 (0.6％,1/167).④ In all 167 adult patients with initial treatment of AML,103 patients achieved CR with a CR rate of 61.7％ after the first induction chemotherapy.In 133 patients with non-AML-M3 subtype,CR rates of AML patients with CD7 and CD34 positive expression were 51.5％ (17/33) and 45.7％ (43/94),which were lower than those of negative expression patients with CR rates of 72.0％ (72/100) and 69.2％ (27/39),and the differences were statistically significant (x2 =4.703,P=0.030;x2 =6.099,P=0.014).The CR rates of AML patients with MPO and CD19 positive expression were 71.3％ (62/87) and 69.6％ (16/23),which were higher than those of negative expression patients with CR rates of 47.8％(22/46) and 46.4％(51/110),and the differences were statistically significant (x2=7.104,P =0.008;x2 =4.096,P =0.043).Conclusions CD33,CD13,CDl17 and MPO are common immune markers of adult patients with initial treatment of AML.CR rates after the first induction chemotherapy of adult patients with initial treatment of AML expressing CD7 and CD34 positive,are lower than those of negative ones,and CR rates of patients with positive expression of MPO and CD19 are higher than those of negative ones.Immunophenotype has great significance for the diagnostic classification and prognosis of AML.