CAJ | 학술논문

目的探讨慢性淋巴细胞白血病(CLL)的免疫表型及核型特征,并分析其在初诊CLL的鉴别诊断价值.方法回顾性分析70例初诊CLL流式细胞术(FCM)免疫表型及其染色体核型特点,结合临床和实验室结果再分析误诊病例.结果 70例初诊CLL免疫表型均表达CD19,其他成熟B细胞相关抗原CD20、CD22阳性率依次为88.5 ％(54/61)及51.9％(27/52),T系相关抗原CD5的阳性率77.1％(54/70),CD5CD19非双阳性表达[CD+5CD+19(-)]CLL共16例(22.9％).34例行CD23检测,阳性率为67.6％(23/34).59例常规染色体核型分析(CC)显示异常核型13例(22.0％),最常见为-y、+12、-20、17号染色体异常,复杂核型5例(8.5％),无分裂象2例,正常39例；10例行CLL组合探针荧光原位杂交(FISH)检查,异常检出率为60％,以GIP D13S25异常检出率最高,为66.6％.CD+5CD+19(-)CLL与CD5 CD19双阳性表达[CD+5CD+19(+)]CLL核型异常发生率差异无统计学意义(P=0.537).对部分临床过程不符合CLL惰性病程再分析,70例初诊CLL中6例误诊,其中CD+5CD+19(+)误诊2例,经荧光原位杂交技术(FISH)t(11;14)及CyclinDl确诊为套细胞淋巴瘤(MCL)；CD+5 CD+19(-)CLL误诊4例,分别为脾边缘区淋巴瘤(SMZL)1例、B淋巴系统增殖性疾病(B-LPD)1例和毛细胞白血病(HCL)2例,误诊率为25.0％,显著高于CD+5CD+19(+)CLL(P=0.030),而CD23的表达显著低于CD+5CD+19(+)CLL(P=0.016).结论 CD+5CD+19(-)CLL误诊率高；CLL的典型免疫表型特征为CD5、CD19、CD23的共表达,联合CD20、CD22表达强弱及核型分析有助于CLL与其他B-LPD鉴别；CC联合FISH检查可提高异常染色体的识别能力.免疫表型联合染色体分析能提高误诊CLL的检出率.
목적 탐토만성림파세포백혈병(CLL)적면역표형급핵형특정,병분석기재초진CLL적감별진단개치.방법 회고성분석70례초진CLL류식세포술(FCM)면역표형급기염색체핵형특점,결합림상화실험실결과재분석오진병례.결과 70례초진CLL면역표형균표체CD19,기타성숙B세포상관항원CD20、CD22양성솔의차위88.5 ％(54/61)급51.9％(27/52),T계상관항원CD5적양성솔77.1％(54/70),CD5CD19비쌍양성표체[CD+5CD+19(-)]CLL공16례(22.9％).34례행CD23검측,양성솔위67.6％(23/34).59례상규염색체핵형분석(CC)현시이상핵형13례(22.0％),최상견위-y、+12、-20、17호염색체이상,복잡핵형5례(8.5％),무분렬상2례,정상39례；10례행CLL조합탐침형광원위잡교(FISH)검사,이상검출솔위60％,이GIP D13S25이상검출솔최고,위66.6％.CD+5CD+19(-)CLL여CD5 CD19쌍양성표체[CD+5CD+19(+)]CLL핵형이상발생솔차이무통계학의의(P=0.537).대부분림상과정불부합CLL타성병정재분석,70례초진CLL중6례오진,기중CD+5CD+19(+)오진2례,경형광원위잡교기술(FISH)t(11;14)급CyclinDl학진위투세포림파류(MCL)；CD+5 CD+19(-)CLL오진4례,분별위비변연구림파류(SMZL)1례、B림파계통증식성질병(B-LPD)1례화모세포백혈병(HCL)2례,오진솔위25.0％,현저고우CD+5CD+19(+)CLL(P=0.030),이CD23적표체현저저우CD+5CD+19(+)CLL(P=0.016).결론 CD+5CD+19(-)CLL오진솔고；CLL적전형면역표형특정위CD5、CD19、CD23적공표체,연합CD20、CD22표체강약급핵형분석유조우CLL여기타B-LPD감별；CC연합FISH검사가제고이상염색체적식별능력.면역표형연합염색체분석능제고오진CLL적검출솔.
Objective To investigate the diagnosis value of immunophenotype and karyotypes in newly diagnosed chronic lymphocytic leukemia (CLL).Methods To retrospect the flow cytometry (FCM) immunophenotype and karyotypes characteristics in newly diagnosed 70 CLL cases.Results In all cases,the positive rates of CD19,CD20,CD5,CD23,CD22 were 100 ％,88.5 ％ (54/61),77.1％ (54/70),67.6 ％ (23/34)and 51.9 ％ (27/52),respectively.And 6 were misdiagnosed,2 was CD+5CD+19(+),but CD20,CD22 were strongly positive,final diagnosed as mantle cell lymphoma (MCL) by FISH t(11;14) examination and CyclinDl; CD+5CD+19(-) CLL were 16 cases (22.9 ％),but 4 were misdiagnosed,the misdiagnosis rate was 25 ％,significantly higher than that of CD+5CD+19(-) CLL (P =0.030).59 cases were examined by conventional cytogcnetic (CC),and 13 cases were with abnormal karyotypes,positive rate was 22.0 ％,with complex karyotypes in 5 cases (8.5 ％); 10 cases combined with FISH abnormalities karyotype examination rate was 60 ％.Conclusion Typical CLL immunophenotypic characteristics were CD5,CD19,CD23 co-expression,and CD－5 CLL with higher misdiagnosis rate,combined with CD20 (,) CD22 expression and karyotype analysis helps to CLL and other B lymphoid proliferative diseases (B-LPD) identification.Conventional cytogenetic detection combined with FISH scan can improve the recognition ability of abnormal chromosome.