本研究应用多参数流式细胞术分析慢性粒单核细胞白血病(CMML),骨髓增生异常综合症(DMS)以及急性单核细胞白血病(AML-M5b)的免疫表型特点,探究其在诊断及鉴别诊断上述疾病中的意义和价值.应用多参数流式细胞术比较分析14例CMML患者、48例MDS患者、46例AML-M5b患者及18例正常人骨髓标本的免疫分型特点.结果表明,CMML患者单核细胞比例明显高于MDS、AML-M5b患者及正常人骨髓(P＜0.05),后3者之间无显著差别.MDS患者骨髓原始细胞比例明显高于正常骨髓标本(P ＜0.05),但与CMML患者无明显差别.AML-M5b患者骨髓成熟粒细胞比例较CMML、MDS患者及正常骨髓标本明显减低(P＜0.05).MDS、AML-M5b及CMML患者骨髓CD45/SSC特点与正常骨髓标本均存在一定差异.CMML患者骨髓具有CD2、CD56异常表达及CD14拖尾现象,与MDS、AML-M5b及正常骨髓标本相比差异显著(P＜0.05).MDS与CMML患者骨髓单核细胞CD15表达缺失或减低现象较正常骨髓标本及AML-M5b患者显著,且CMML患者异常率高于MDS患者(P＜0.05),两者粒细胞群均有显著CD13/CD11b/CD16表达规律异常现象,但两者间无显著差异.其他抗原表达呈不同程度异常,无统计学差异.结论MDS、CMML及AML-M5b骨髓细胞免疫表型均具有各自的特点及不同程度的相似处.多参数流式细胞术综合分析其免疫表型,对于区分CMML、MDS以及AML-M5b具有重要鉴别意义.其中单核细胞比例增高,伴有CD2、CD56异常表达,CD14拖尾现象,CD15缺失或减低及成熟粒细胞CD13-CD11b-CD16表达规律异常,对CMML诊断具有重要意义.%This study was purposed to analyse the immunophenotypic characteristics of chronic myelomonocytic leukemia ( CMML), myelodysplastic syndromes ( MDS) and acute monocytic leukemia ( AML-M5b) by using multiparameter flow cytometry, and to exprole its significanse in diagnosis and differential diagnosis. The immunophenotypic characteristics of bone marrow samples from 14 CMML patients, 48 MDS patients, 46 AML-M5b patients and 18 normal persons were analyzed and compared by multiparainetric flow cytometry. The results showed that the ratio of monocytes in CMML patients was obviously higher than that in MDS, AML-MSb patients and normal persens (P < 0. 05), but there was no statistically significant difference between bone marrow samples of MDS and AML-M5b patients as well as normal persons. The ratio of blast cells in MDS patients was obviously higher than that in normal persons (P < 0. 05), but did not show significant difference as compared with CMML patients. The ratio of mature granocytes in AML-M5b patients was obviously lower than that in CMML and MDS patients as well as normalrnperson bone marrow (P < 0. 05). Certain differences of CD45/SSC characteristics in MDS, AML-M5b and CMML patients were found in comparison with normal persons. The abnormal expression of CD2, CD56, and CD14 tailing phenomenon were observed in CMML patients in comparison with bone marrow sanaples of MDS,AML-M5b and normal persons (P <0.05). Lack and decrease of CD 15 expression in MDS and CMML patients was significant different from AML-M5b and normal persons marrow, abnormal expression rate of CD15 in CMML patients was higher than that in MDS patients (P<0.05) , the CD13/CD11b/CD16 abnomal expression of granulocytes was seen in both CMML and MDS patients, but there was no statistically significant difference between them. Other antigens showed abnormality of varing degrees, but did not have any statistical significance. It is concluded that MDS. CMML and AML-M5b displayed a certain degree of similarity, and also possess their own immunophenotype characteristics. Comprehensive analysis of immunophenotype by multiparameter flow cytometry may be important for differential diagnosis among CMML, MDS and AML-M5b. High percentage of monocytes, abromal coexpression of CD2, CD56 and CD14 tailing phenomenon, lack or decrease of CD15 as well as abnormal expression of CD13/CD1 lb/CD16 in granulocytes may play important roles in diagnosis of CMML.
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