CAJ | 학술논문

目的分析造血B祖细胞与急性B淋巴细胞白血病(B-ALL)细胞在形态学、免疫表型等方面的差异,为造血B祖细胞、微小残留白血病细胞的正确鉴定提供参考.方法采用流式细胞术对临床确诊的58例B-ALL患者初诊、缓解、复发期的132份骨髓样本进行细胞免疫表型分析,通过CD34/CD10/CD19/CD45或CD34/CD10/CD45/CD19/CD20/CD38抗体组合鉴定造血B祖细胞群.结果 132份骨髓样本中,45份(34％)检出造血B祖细胞群,检测范围0～36％,其中3份样本出现在初诊病例,1份样本出现在复发病例,41份样本出现在缓解病例.66份缓解病例样本中,造血B祖细胞检出率为62％(41/66).白血病细胞在初诊、复发病例中均占有核细胞群体5％以上,24份缓解病例样本可检出低于5％的残留白血病细胞.造血B祖细胞与白血病细胞共存在28份样本中,其中3份出现在初诊病例,1份出现在复发病例,24份出现在缓解病例.造血B祖细胞CD45呈阴性至弱阳性连续分布,侧向散射信号(SSC)较低,早期造血B祖细胞群CD34+,随着细胞成熟度的增加,CD34消失.CD19、CD10在造血B祖细胞整个阶段均为阳性,早期CD10表达强度更高.白血病细胞呈“发育阻滞”模式,呈现为较均一的荧光细胞群;SSC值较正常B祖细胞偏高.白血病细胞抗原表达过强或过低的表型在正常造血B祖细胞均未见到,且造血B祖细胞不会出现交叉系列抗原标记,CD20呈阴性至弱阳性的连续分布.结论造血B祖细胞在B-ALL患者不同阶段均不同程度地存在,尤其在化疗后的骨髓恢复期有一过性增长,分析此阶段的样本鉴定B系群体来源需谨慎.了解正常细胞的发育背景、认知白血病细胞表型的漂移变化模式及掌握多色分析优化抗体组合的流式细胞技术,对白血病细胞的准确鉴定及微小残留病检测的准确性提升具有重要意义.
목적 분석조혈B조세포여급성B림파세포백혈병(B-ALL)세포재형태학、면역표형등방면적차이,위조혈B조세포、미소잔류백혈병세포적정학감정제공삼고.방법 채용류식세포술대림상학진적58례B-ALL환자초진、완해、복발기적132빈골수양본진행세포면역표형분석,통과CD34/CD10/CD19/CD45혹CD34/CD10/CD45/CD19/CD20/CD38항체조합감정조혈B조세포군.결과 132빈골수양본중,45빈(34％)검출조혈B조세포군,검측범위0～36％,기중3빈양본출현재초진병례,1빈양본출현재복발병례,41빈양본출현재완해병례.66빈완해병례양본중,조혈B조세포검출솔위62％(41/66).백혈병세포재초진、복발병례중균점유핵세포군체5％이상,24빈완해병례양본가검출저우5％적잔류백혈병세포.조혈B조세포여백혈병세포공존재28빈양본중,기중3빈출현재초진병례,1빈출현재복발병례,24빈출현재완해병례.조혈B조세포CD45정음성지약양성련속분포,측향산사신호(SSC)교저,조기조혈B조세포군CD34+,수착세포성숙도적증가,CD34소실.CD19、CD10재조혈B조세포정개계단균위양성,조기CD10표체강도경고.백혈병세포정“발육조체”모식,정현위교균일적형광세포군;SSC치교정상B조세포편고.백혈병세포항원표체과강혹과저적표형재정상조혈B조세포균미견도,차조혈B조세포불회출현교차계렬항원표기,CD20정음성지약양성적련속분포.결론 조혈B조세포재B-ALL환자불동계단균불동정도지존재,우기재화료후적골수회복기유일과성증장,분석차계단적양본감정B계군체래원수근신.료해정상세포적발육배경、인지백혈병세포표형적표이변화모식급장악다색분석우화항체조합적류식세포기술,대백혈병세포적준학감정급미소잔류병검측적준학성제승구유중요의의.
Objective To discriminate morphology and immunophenotype differences between hematogones and lymphoblast to provide some references for the correct identification of hematogones and minimal residual leukemia cells.Methods Immunophenotypes were detected by flow cytometry in a total of 132 bone marrow from 58 patients with acute B lymphoblastic leukemia during diagnosis,remission and relapse.Hematogones were identified based on combination of CD34/CD10/CD19/CD45 or CD34/CD10/CD45/CD19/CD20/CD38.Results Among 132 specimens,45 (34 ％) were identified hematogones,the detection range was 0-36 ％.Three specimens appeared in diagnosis patients,one in relapse,and the remaining 41 cases in remission.The detection rate of hematogones was 62 ％ (41/66) in the remission cases.More than 5 ％ leukemia cells of nucleated cells were detected in diagnosis and relapse,and less than 5 ％ residual leukemia cells was in 24 specimens from remission patients.In 28 specimens,the co-existence of hematogones and leukemia cells was found,including three in diagnosis,one in relapse and the remaining 24 in remission.Hematogones were characterized in term of variable expression of CD45 and very low side scatter.The early hematogones expressed CD34.With maturation increasing,hematogones gradually lacked CD34.CD19 and CD10 were presented in whole hematogones stage.Early hematogones had expression of CD10.Lymphoblasts showed maturation arrest and more homogeneous populations.SSC values of hematogones were higher than that of normal B cell progenitors.Antigen overexpression or underexpression was not found in normal hematopoietic progenitor B cells,and hematopoietic progenitor B cells did not appear cross-lineage markers,CD20+ cells exhibited continuous distribution from negative to weak positive for normal hematogones.Conclusions Hematogones were present in diagnosis,remission and relapse cases with acute B lymphoblastic leukemia,especially abundant in bone marrow after chemotherapy.It should be careful to diagnose and discriminate the malignant cells from benign cells.By comprehending continuous and complete maturation spectrum of antigen expression for normal hematogones,knowing phenotype of leukemia cells drift change patterns and using multiparameter flow cytometry and optimal antibody combination,it is significant in identifying residual lymphoblasts from hematogones and improving the detection accuracy in minimal residual disease.