CAJ | 학술논문

目的探讨急性淋巴细胞性白血病(ALL)患儿中CD38的表达特点以及与临床预后的关系,以指导个体化治疗.方法 79例儿童急性淋巴细胞性白血病(B系)初发者,入院后均应用流式细胞仪进行免疫分型,并同时进行微小残留病变(MRD)的筛选,当抗原表达符合CD38低表达时,进一步与其他3色抗体(CD10、CD19和CD34)一起进行共4色的抗体组合检测,作为筛选指标进行进一步的监测.根据CD38表达将ALL患儿分为CD38高表达组和CD38低表达组,对两组进行免疫分型特点、危险分层和生存时间的比较,统计分析使用SPSS16.0软件,P＜0.05为差异有统计学意义.结果初发急性淋巴细胞性白血病(B系)患儿共79例,CD38低表达组为50/79例(63.3％),CD38高表达组为29/79例(36.7％)；79例患儿中仅存在CD38/CD10/CD34/CD19一个筛选指标的4例,包含CD38/CD10/CD34/CD19且≥2个其他筛选指标(如TdT/CD10/CD34/CD19、CD66c/CD10/CD34/CD19和CD45/CD10/CD34/CD19等)的46例,无筛选指标的18例.危险分层中CD38低表达、CD38高表达两组分别为低危21/5例,中危14/15例,高危15/9例.CD38低表达组中early Pre-B 33例,Pre-B 12例,Mature-B 5例,CD38高表达组中early Pre-B 21例,Pre-B 5例,Mature-B 3例；两组中CD38高表达组的高危分层明显大于CD38低表达组(F=6.24,P=0.044),并且生存时间明显小于CD38低表达组,差异有统计学意义(x2=5.22,P=0.022).结论 CD38低表达时可作为急性淋巴细胞性白血病的MRD监测指标,CD38高表达组生存时间缩短,可能为ALL预后不良的独立危险因素.
목적 탐토급성림파세포성백혈병(ALL)환인중CD38적표체특점이급여림상예후적관계,이지도개체화치료.방법 79례인동급성림파세포성백혈병(B계)초발자,입원후균응용류식세포의진행면역분형,병동시진행미소잔류병변(MRD)적사선,당항원표체부합CD38저표체시,진일보여기타3색항체(CD10、CD19화CD34)일기진행공4색적항체조합검측,작위사선지표진행진일보적감측.근거CD38표체장ALL환인분위CD38고표체조화CD38저표체조,대량조진행면역분형특점、위험분층화생존시간적비교,통계분석사용SPSS16.0연건,P＜0.05위차이유통계학의의.결과 초발급성림파세포성백혈병(B계)환인공79례,CD38저표체조위50/79례(63.3％),CD38고표체조위29/79례(36.7％)；79례환인중부존재CD38/CD10/CD34/CD19일개사선지표적4례,포함CD38/CD10/CD34/CD19차≥2개기타사선지표(여TdT/CD10/CD34/CD19、CD66c/CD10/CD34/CD19화CD45/CD10/CD34/CD19등)적46례,무사선지표적18례.위험분층중CD38저표체、CD38고표체량조분별위저위21/5례,중위14/15례,고위15/9례.CD38저표체조중early Pre-B 33례,Pre-B 12례,Mature-B 5례,CD38고표체조중early Pre-B 21례,Pre-B 5례,Mature-B 3례；량조중CD38고표체조적고위분층명현대우CD38저표체조(F=6.24,P=0.044),병차생존시간명현소우CD38저표체조,차이유통계학의의(x2=5.22,P=0.022).결론 CD38저표체시가작위급성림파세포성백혈병적MRD감측지표,CD38고표체조생존시간축단,가능위ALL예후불량적독립위험인소.
Objective To investigate CD38 expression characteristic and the relation of clinic prognosis in children with acute lymphoblastic leukemia,in order to improve individual treatment.Methods Seventy-nine patients with childhood acute lymphoblastic leukemia(B-lineage) were enrolled into this study.Four-color fluorochrome labeled monoclonal antibodies were applyed to analyze the cell immunophenotypes and minimal residual disease screening.When CD38 low-expression was considered to be the effective screening marker and be used to continue monitoring.All patients were divided into CD38 low-expression groups and CD38 high-expression groups,to compared the immunophenotyping characteristic,risk stratification and survive rate of the two groups.All datas were assessed by means of SPSS16.0 and a P value of 0.05or less was considered to indicate statistical significance.Results All of 79 newly diagnosed ALL-B,The group of CD38 low-expression were 50/79 (63.3％) while the other group were 29/79(36.7％).of all patients,11 chilldren showed only a screening indicator-CD38/CD10/CD34/CD19,while 46 belonged to more than one markers (Such as TdT/CD10/CD34/CD19,CD66c/CD10/CD34/CD19 and CD45/CD10/CD34/CD19) and 18 no markers.The stratification of CD38 low-expression and CD38 high-expression groups as follows:21/5 patients with low-risk,14/15 with medium risk and 15/9 with high-risk.In the CD38 low-expression group,Early Pre-B 33,Pre-B 12,Mature-B 5,while in the CD38 high-expression group,Early Pre-B 21,Pre-B 5,Mature-B 3.This study showed that the high-risk stratification in the CD38 high-expression group was obviously higher than the CD38 low-expression group(F=6.24,P=0.044),but the survival time was signicantly shorter than CD38 low-expression group (x2 ＝ 5.22,P =0.022) and the difference was statistically significant.Conclusion CD38 as a MRD monitoring indicator of most acute lymphoblastic leukemia when it low-expression,CD38 high-expression in newly diagnosis childhood acute lymphoblastic leukemia(B-lineage) may be an independent risk factor for predicting poor prognosis.