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目的:探讨伴CD4、CD7表达的AML病人免疫分型特点及分子生物学和细胞遗传学特征。方法:应用四色流式细胞术,以CD45设门,检测304例病人白血病细胞的免疫表型;RT-PCR方法检测WT1、MDK、ETO、PMLRaRa、BCR-ABL分子生物学标志;R显带技术分析白血病细胞核型变化。根据免疫分型结果,将病人分为3组:伴CD7表达的AM L组,伴CD4表达的AM L组(CD4组),无T系抗原表达的AM L组(common AM L组)。结果:CD7组患者HLA-DR表达率和表达量均高于无T系抗原表达AM L组,CD34、CD33表达率高于无T系抗原表达AM L组和CD4组;CD4组患者CD15、CD64的表达率和表达量均高于CD7组和无T系抗原表达AM L组,CD33表达率、表达量高于无T系抗原表达AML组,差异有统计学意义(P<0.05);CD7组患者WT1表达低于无T系抗原表达AML组,差异有统计学意义(P<0.05),在CD7组患者未发现PML-RaRa表达。伴有CD4、CD7表达的AM L组正常核型的比例高于无T系抗原表达AM L组。伴有CD7表达的AM L患者中无1例发生t(15;17)。结论:伴有CD7表达的AML的白血病细胞来源于前体细胞,被阻滞在造血发育的早期阶段;伴有CD4表达的AML白血病细胞起源于相对成熟的阶段,高表达CD33、CD64、CD15;伴有CD7、CD4表达的AML无特异性的细胞遗传学改变。根据CD4、CD7的表达量和强度,联合髓系标志可定量检测AML病人MRD。
Objective: To investigate the immunophenotypic characteristics, molecular biology and cytogenetic characteristics of AML patients with CD4, CD7 expression. Methods: Four-color flow cytometry was used to detect the immunophenotype of leukemia cells in 304 patients with CD45. The molecular markers of WT1, MDK, ETO, PMLRaRa and BCR-ABL were detected by RT-PCR. Technical analysis of leukemic cell karyotype changes. According to the results of immunophenotyping, the patients were divided into 3 groups: AM L group with CD7 expression, AM L group with CD4 expression (CD4 group), and AM L group without T cell antigen (common AM L group). Results: The expression of HLA-DR in CD7 group was higher than that in AML group without T cell antigen expression. The expression of CD34 and CD33 in CD7 group was higher than that in AM L group and CD4 group without T cell antigen. CD15, CD64 (P <0.05). The expression of CD33 and CD33 in CD7 group and non-T cell antigen group were significantly higher than that in CD7 group and non-T cell antigen group (P <0.05) The expression of WT1 in patients with AML was lower than that in AML without T cells (P <0.05). No expression of PML-RaRa was found in CD7 patients. The proportion of normal karyotypes in AM L group with CD4 and CD7 expression was higher than that in AM L group without T cell antigen expression. None of the AM L patients with CD7 expression developed t (15; 17). Conclusion: AML leukemia cells with CD7 expression are derived from precursor cells and are arrested in the early stage of hematopoietic development. AML leukemia cells with CD4 expression originated in a relatively mature stage with high expression of CD33, CD64 and CD15. AML with CD7, CD4 expression has no specific cytogenetic changes. According to the expression and intensity of CD4 and CD7, combined with myeloid markers can be quantitative detection of MRD in patients with AML.