CAJ | 학술논문

目的：解决急性早幼粒细胞白血病（M3）目前国内因粗细颗粒混杂而造成的分型困难。方法以粗颗粒型早幼粒细胞的百分率进行分型，规定：粗颗粒型早幼粒细胞>70%为 M3a（粗颗粒型）；30%<粗颗粒型早幼粒细胞≤70%为 M3b（混合颗粒型）；粗颗粒型早幼粒细胞≤30%为 M3c（细颗粒型）。结果208例急性早幼粒细胞白血病，其三种亚型的发生率 M3a 为42.31%，M3b 为30.13%，M3c 为27.56%；性别分布 M3a男性明显多于女性，M3b无性别差异，M3c女性明显多于男性；年龄分布 M3a < M3b <M3c；初诊时发热症状 M3b最多见，M3a次之，M3c 较少见；出血情况 M3a 最多见，M3b 次之，M3c 较少见；部分M3a、M3b的病例胸骨压痛明显，M3c未见有之。M3a部分病例有肝肿大，M3b与 M3c未见肝肿大者；三型的的部分病例均见有脾肿大；但三者之间无明显差异（P >0.05）。淋巴结肿大以 M3b为多，M3a 次之，M3c 未见肿大者。Hb、RBC、BPC、WBC 的均值 M3a < M3b < M3c；外周血中早幼粒细胞的数值 M3c > M3a > M3b；骨髓有核细胞的增生 M3a多为增生极度活跃，M3b、M3c多为增生明显活跃；粒红比值、早幼粒细胞的百分率、粗颗粒型早幼粒细胞的比值均 M3a > M3b > M3c；Auer 小体的发生 M3b多见，M3c较少见，M3a不易见。结论三种亚型不论在性别、年龄分布上，还是在主要临床症状、血象、骨髓象上均有不同的表现与特征。此分型标准对于指导临床治疗和判断预后具有现实意义。
목적：해결급성조유립세포백혈병（M3）목전국내인조세과립혼잡이조성적분형곤난。방법이조과립형조유립세포적백분솔진행분형，규정：조과립형조유립세포>70%위 M3a（조과립형）；30%<조과립형조유립세포≤70%위 M3b（혼합과립형）；조과립형조유립세포≤30%위 M3c（세과립형）。결과208례급성조유립세포백혈병，기삼충아형적발생솔 M3a 위42.31%，M3b 위30.13%，M3c 위27.56%；성별분포 M3a남성명현다우녀성，M3b무성별차이，M3c녀성명현다우남성；년령분포 M3a < M3b <M3c；초진시발열증상 M3b최다견，M3a차지，M3c 교소견；출혈정황 M3a 최다견，M3b 차지，M3c 교소견；부분M3a、M3b적병례흉골압통명현，M3c미견유지。M3a부분병례유간종대，M3b여 M3c미견간종대자；삼형적적부분병례균견유비종대；단삼자지간무명현차이（P >0.05）。림파결종대이 M3b위다，M3a 차지，M3c 미견종대자。Hb、RBC、BPC、WBC 적균치 M3a < M3b < M3c；외주혈중조유립세포적수치 M3c > M3a > M3b；골수유핵세포적증생 M3a다위증생겁도활약，M3b、M3c다위증생명현활약；립홍비치、조유립세포적백분솔、조과립형조유립세포적비치균 M3a > M3b > M3c；Auer 소체적발생 M3b다견，M3c교소견，M3a불역견。결론삼충아형불론재성별、년령분포상，환시재주요림상증상、혈상、골수상상균유불동적표현여특정。차분형표준대우지도림상치료화판단예후구유현실의의。
Objective:To find practical solutions to the difficulties in typing of acute hepergranular promyelocytic leukemia(M3 )due to mixed - up of fine and coarse granules. Methods:The proposed typ-ing,based on the percentage of leukemia cells with coarse granules in the cytoplasm,divided M3 into three subtypes:M3a(coarse granule subtype)in which > 70% of the leukemia cells contained coarse granules,M3b( mixed granule subtype)in which 30% to 70% of the leukemia cells contained coarse granules,and M3c(fine granule subtype)in which ≤30% of the leukemia cells contained coarse gran-ules. The relationship between the new typing system and the clinico - pathologic characteristics were studied. Results:Among the 208 cases of APL,M3a ,M3b ,and M3c accounted for 42. 31% ,30. 29%and 27. 4% ,respectively. There was a different sex distribution pattern among the three subtypes,with male dominance in M3a subtype,female dominance in M3c subtype and no sex dominance in M3b subtype. The age distribution pattern was that M3a < M3b < M3c . Fever as the first presenting symptom was most frequently observed in M3b patients,followed by M3a and M3c. Hemorrhage was most frequent in M3a ,fol-lowed by M3b and then M3c. Stern tenderness was observed in some M3a and M3b patients,but not in M3c patients. There are some patients with hepatomegally in some M3a subtypes but not in M3b or M3c sub-types. Splenomegaly was observed in some patients of all the three subtypes(P > 0. 05). Lymph node enlargement was most frequently observed in M3b ,followed by M3a and then M3c . The average levels of peripheral blood hemoglobin,red blood cell count,platelets count and white blood cell count were M3a <M3b < M3c. The percentage of peripheral blood promyelocytic leukemia cells was M3c > M3a > M3b. Bone marrow study showed extremely proliferating nuclear cells in M3a subtype,and significantly proliferating nuclear cells in M3b and M3c subtypes. The granulocyte / erythrocyte ratio,promyelocyte percentage, coarse granule promylocyte percentage were M3a > M3b > M3c. Auer bodies were most frequently observed in M3b ,followed by M3c and then M3a. Conclusions:The three subtypes were different in age and sex dis-tribution,clinical signs and symptoms,and peripheral blood and bone marrow smear characteristics. The proposed typing could be of reference value for treatment and prognosis.