• 綿陽市人民醫(yī)院檢驗科（四川綿陽，621000）;

【摘要】　目的　 分析交叉抗原表達(dá)的急性白血病的臨床特征及緩解率。　方法　 對2009年10月-2010年11月血液內(nèi)科的210例交叉表達(dá)髓系和淋巴細(xì)胞系相關(guān)抗原的初治急性白血病患者的標(biāo)本，采用流式細(xì)胞術(shù)檢測白血病細(xì)胞的免疫表型，根據(jù)免疫標(biāo)記和FAB（French、American、Britain）分型進(jìn)行分組，分析其異質(zhì)性的生物學(xué)特征和影響緩解率的相關(guān)因素。　結(jié)果　 210例急性白血病的FAB分型以AML-M1/M2（82例）和ALL（78例）為主；免疫分型以B淋巴細(xì)胞系和髓系混合表達(dá)多見（116例），其中CD34表達(dá)率高達(dá)91.4%（192例）， CD7表達(dá)率為50.5%（106例），且與CD34相關(guān)（P=0.04）；出現(xiàn)CD34、CD7、CD19三者共表達(dá)的患者緩解率較低（9.09%）。　結(jié)論　 交叉抗原表達(dá)的急性白血病的診斷有賴于免疫分型的判斷，其分化抗原的表達(dá)類型是影響其緩解率的重要因素。
【Abstract】　Objective　 To observe the clinical characters of acute leukemia with cross-lineage antigen expression and analyze the remission rate.　Methods　 Between October 2009 and November 2010, 210 patients were diagnosed and classified by morphology. Cytochemistry and immunology were used to analyze the immunophenotype. According to the immunostaining relative factors and FAB (French, American, and Britain) phenotype standard, the samples were divided into several groups. The conical characters and relative factors of remission rate were analyzed.　Results　 In 210 patients with cross-lineage antigen expression, AL, AML-M1/M2 (82 cases) and ALL (78 cases) were common in FAB phenotype,and cross-lineage of B lineage and myelolineage were common in immunotype (116 cases). CD34 got the highest expression frequency of all (192 cases),and had the most important effect on patients′ prognosis. CD7 was also positive commonly (106 cases) and related with CD34 (P=0.04). So it′s significant for the outcome. The patients who got co-expression of CD34, CD7 and CD19 had worse prognoses.　Conclusions　 Acute leukemia with cross-lineage antigen expression is a special type and is confirmed by immunotype. Furthermore, expression types of differentiation antigen are critical for the prognosis.

引用本文： 楊琴. 交叉抗原表達(dá)的急性白血病的臨床生物學(xué)特征分析. 華西醫(yī)學(xué), 2011, 26(11): 1687-1689. doi: 復(fù)制

1. 　Xu XQ, Wang JM, Lü SQ, et al. Clinical and biological characteristics of adult biphenotypic acute leukemia in comparison with that of acute myeloid leukemia and acute lymphoblastic leukemia: a case series of a Chinese population[J]. Haematologica, 2009, 94(7): 919-927.
2. 　Bene MC, Castoldi G, Knappe W, et al. Proposals for the immunological classification of acute leukemias. European Group for the Immunological Characterization of Leukemias (EGIL)[J]. Leukemia, 1995, 9(10): 1783-1786.
3. 　Mejstrikova E, Volejnikova J, Fronkova E, et al. Prognosis of children with mixed phenotype acute leukemia treated on the basis of consistent immunophenotypic criteria[J]. Haemotologica, 2010, 95(6): 928-935.
4. 　Drexler HG, Thiel E, Ludwig WD. Acute myeloid leukemias expressing lymphoid-associated antigens: diagnostic incidence and prognostic significance[J]. Leukemia, 1993, 7(4): 489-498.
5. 　肖志堅, 郝玉書. 免疫表型與急性白血病的診斷[J]. 中華血液學(xué)雜志, 1997, 18(3): 53-55.
6. 　Kita K, Miwa H, Nakase K, et al. Clinical importance of CD7 expression in acute myelocytic leukemia[J]. Blood, 1993, 81(9): 2399-2405.
7. 　李耀華, 徐娟. CD7在成人急性髓細(xì)胞白血病的表達(dá)及在微小殘留病檢測中的應(yīng)用[J]. 首都醫(yī)科大學(xué)學(xué)報, 2006, 27(2): 233-234.
8. 　Legrand O, Perrot JY, Simonin G, et al. Adult biphenotypic acute leukemia: an entity with poor prognosis which is related to unfavourable cytogenetics and P-glycoprotein over-expression[J]. Br J Haematol, 1998, 100(1): 147-155.
9. 　Suzuki R, Nakamura S. Malignancies of natural killer (NK) cell precursor: myeloid/NK cell precursor acute leukemia and blastic NK celllymphoma/leukemia[J]. Leuk Res, 1999, 23(7): 615-624.
10. 　Daniels JT, Davis BJ, Houde-McGrail L, et al. Clonal selection of CD56+ t(8;21) AML blasts: further suggestion of the adverse clinical significance of this biological marker?[J]. Br J Haematol, 1999, 107(2): 381-383.
  1. 1. 　Xu XQ, Wang JM, Lü SQ, et al. Clinical and biological characteristics of adult biphenotypic acute leukemia in comparison with that of acute myeloid leukemia and acute lymphoblastic leukemia: a case series of a Chinese population[J]. Haematologica, 2009, 94(7): 919-927.
  2. 2. 　Bene MC, Castoldi G, Knappe W, et al. Proposals for the immunological classification of acute leukemias. European Group for the Immunological Characterization of Leukemias (EGIL)[J]. Leukemia, 1995, 9(10): 1783-1786.
  3. 3. 　Mejstrikova E, Volejnikova J, Fronkova E, et al. Prognosis of children with mixed phenotype acute leukemia treated on the basis of consistent immunophenotypic criteria[J]. Haemotologica, 2010, 95(6): 928-935.
  4. 4. 　Drexler HG, Thiel E, Ludwig WD. Acute myeloid leukemias expressing lymphoid-associated antigens: diagnostic incidence and prognostic significance[J]. Leukemia, 1993, 7(4): 489-498.
  5. 5. 　肖志堅, 郝玉書. 免疫表型與急性白血病的診斷[J]. 中華血液學(xué)雜志, 1997, 18(3): 53-55.
  6. 6. 　Kita K, Miwa H, Nakase K, et al. Clinical importance of CD7 expression in acute myelocytic leukemia[J]. Blood, 1993, 81(9): 2399-2405.
  7. 7. 　李耀華, 徐娟. CD7在成人急性髓細(xì)胞白血病的表達(dá)及在微小殘留病檢測中的應(yīng)用[J]. 首都醫(yī)科大學(xué)學(xué)報, 2006, 27(2): 233-234.
  8. 8. 　Legrand O, Perrot JY, Simonin G, et al. Adult biphenotypic acute leukemia: an entity with poor prognosis which is related to unfavourable cytogenetics and P-glycoprotein over-expression[J]. Br J Haematol, 1998, 100(1): 147-155.
  9. 9. 　Suzuki R, Nakamura S. Malignancies of natural killer (NK) cell precursor: myeloid/NK cell precursor acute leukemia and blastic NK celllymphoma/leukemia[J]. Leuk Res, 1999, 23(7): 615-624.
  10. 10. 　Daniels JT, Davis BJ, Houde-McGrail L, et al. Clonal selection of CD56+ t(8;21) AML blasts: further suggestion of the adverse clinical significance of this biological marker?[J]. Br J Haematol, 1999, 107(2): 381-383.