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目的探讨急性髓系白血病(AML)患者免疫表型和白血病相关的免疫表型(LAIP)特征及在微量残留病(MRD)检测中的意义。方法采用 CIM5/SSC 设门四色流式细胞术,检测610例AML 患者和20名健康志愿者下列抗原的表达:CD7、CD117、CD33、CD34、CD10、CD19、CD56、CD38、CD13、CD14、CD64、CD9、CD16、CD2、CD5、CD11b、CD123、HLA-DR。结果正常骨髓中 CD34~+和CD117~+SSC 值低(SSC~(low))的细胞比例分别为(0.35±0.15)%和(0.76±0.31)%。CD34~+SSC~(low)细胞中绝大多数细胞共表达 CD13、CD33、CD38、CD117、HLA-DR(84%～94%)。CD9和 CD15的相对比例为20%和33%,而 CD11b、CD56、CD19和 CD64的相对比例均低于10%,CD7为12%。CD117~+SSC~(low)细胞中,CD19~+、CD11b~+、CD56~+和 CD7~+细胞相对比例低于10%,CD9~+细胞为14%,CD38~+和 HLA-DR~+细胞的相对比例为87%和91%,其余抗原(CD15、CD13、CD33、CD34)均在30%～50%。AML 患者中 CD117、CD38表达率约为95%,CD33、CD9表达率约为84%。HLA-DR 和 CD13表达率分别为77.23%和75.25%。CD64和 CD34的表达率分别为64.41%和59.51%。CD15表达率为43.06%,CD11b 表达率为22.07%。86.39%的 AML 患者 LAIP 阳性,以 AML-M_1和 M_3最高,AML-M_(4Eo)最低。LAIP 主要表现为交叉系列抗原表达和非同期共抗原表达,前者以 CD34与 CD7、CD19、CD56同时阳性为主。在非同期抗原表达中,CD34~+CD64~+、CD117~+CD11b~+、CD117~+CD38~(-/dim)、CD117~+HLA-DR~(-/dim)正常值在0.01%左右,与 AML 之间的对数差大于3,为灵敏度较高的 LAIP。结论多参数流式细胞术适于80%以上 AML 患者 MRD 检测。
Objective To investigate the characteristics of immunophenotype and leukemia-related immunophenotype (LAIP) in patients with acute myeloid leukemia (AML) and its significance in the detection of minimal residual disease (MRD). Methods CIM5 / SSC was used to detect the expression of the following antigens in 610 AML patients and 20 healthy volunteers: CD7, CD117, CD33, CD34, CD10, CD19, CD56, CD38, CD13, CD14, CD64, CD9, CD16, CD2, CD5, CD11b, CD123, HLA-DR. Results The percentage of cells with low CD34 + and CD117 + SSC values (SSC low) in normal bone marrow was (0.35 ± 0.15)% and (0.76 ± 0.31)%, respectively. The vast majority of CD34 ~ + SSC ~ (low) cells co-expressed CD13, CD33, CD38, CD117 and HLA-DR (84% -94%). The relative proportions of CD9 and CD15 are 20% and 33%, while the relative proportions of CD11b, CD56, CD19 and CD64 are both less than 10% and CD7 is 12%. The relative percentage of CD19 ~ +, CD11b ~ +, CD56 ~ + and CD7 ~ + cells was less than 10% in CD117 ~ + SSC ~ + Cells relative proportions of 87% and 91%, the remaining antigens (CD15, CD13, CD33, CD34) are 30% to 50%. AML patients CD117, CD38 expression rate of about 95%, CD33, CD9 expression rate of about 84%. The expression rates of HLA-DR and CD13 were 77.23% and 75.25% respectively. The expression rates of CD64 and CD34 were 64.41% and 59.51% respectively. CD15 expression rate was 43.06%, CD11b expression rate was 22.07%. LAA was positive in 86.39% of AML patients, with the highest AML-M_1 and M_3 and the lowest AML-M_ (4Eo). LAIP mainly manifested as cross-lineage antigen expression and non-synchronous co-antigen expression, the former with CD34 and CD7, CD19, CD56 positive at the same time. The expression of CD34 + CD64 +, CD117 ~ + CD11b ~ +, CD117 ~ + CD38 ~ (- / dim) and CD117 ~ + HLA-DR ~ (- The logarithmic difference from AML is greater than 3 for a more sensitive LAIP. Conclusion Multiparameter flow cytometry is suitable for detecting MRD in more than 80% of AML patients.