目的 探討嬰兒急性白血病（IAL）的臨床與實驗室檢查特征。 方法 對1999年12月－2011年6月收治的15例嬰兒急性白血病的臨床資料進行總結與分析。 結果 其中急性淋巴細胞白血病（ALL）6例，急性髓系白血病（AML）8例，分類不明1例，其中以M4（4例）、M5（3例）為主。臨床表現多樣，髓外浸潤明顯。1例細胞形態學與免疫分型有差異，1例合并染色體異常。放棄治療者11例，死亡2例，正規治療的2例于誘導緩解后獲完全緩解。 結論 IAL預后差，需完善相關檢查并不斷總結臨床資料以提高IAL治愈率。
Continuous activation of Janus kinase (JAK)- signal transduction and activator of transcription (STAT) signaling pathway is prevalent in leukemia cells, and it has been found that this pathway plays an important role in acute leukemia (AL). JAK2/JAK1 gene mutations are found in both acute myelocytic leukemia and acute lymphoblastic leukemia and may have implications for the treatment and overall prognosis of the disease. Among the STAT family members, STAT3 and STAT5 proved to be key factors in AL. These gene mutations may provide new targets and new ideas for the treatment of AL. This article provides a review of the research progress of JAK-STAT signaling pathway, related gene mutations and AL.
【摘要】 目的 分析交叉抗原表達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月血液內科的210例交叉表達髓系和淋巴細胞系相關抗原的初治急性白血病患者的標本，采用流式細胞術檢測白血病細胞的免疫表型，根據免疫標記和FAB（French、American、Britain）分型進行分組，分析其異質性的生物學特征和影響緩解率的相關因素。 結果 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淋巴細胞系和髓系混合表達多見（116例），其中CD34表達率高達91.4%（192例）， CD7表達率為50.5%（106例），且與CD34相關（P=0.04）；出現CD34、CD7、CD19三者共表達的患者緩解率較低（9.09%）。 結論 交叉抗原表達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.
The poor treatment effect and short survival period of patients with acute leukemia are mainly due to the lack of effective early diagnosis and treatment targets. Lipid metabolism reprogramming meets the material and energy requirements for rapid proliferation and division of tumor cells, and is associated with the invasiveness, recurrence, and chemotherapy resistance of acute leukemia. This article reviews the carcinogenic and chemotherapy resistance mechanisms of lipid metabolism reprogramming in leukemia cells, and summarizes the latest findings on targeted fatty acid metabolism pathways, aiming to provide a new perspective on the role of intracellular fatty acid metabolism in the occurrence and development of acute leukemia. It is expected to provide a theoretical basis for the elucidation of its resistance mechanism and the development of corresponding targeted therapies.
Objective To investigate the expression of Bcl-2 in acute leukemia of different pathological states and its relationship with chemotherapeutic efficacy. Methods Case-control studies and cohort studies were collected by searching the electronic bibliographic databases such as CBMdisc (1979 to 2010), Chinese Sic-tech Periodical Full-text Database (1989 to 2010), WanFang (1982 to 2010), Chinese Journals Full-text Database (since 1994), China Master’s Theses Full-text Database (since 1999), and China Doctor Dissertations Full-text Database (since 1999). All the relevant studies were identified and the quality of the included studies was assessed. The RevMan 5.0 software was used for meta-analysis. Results A total of 10 studies were included. The results of meta analyses showed: the complete remission of acute leukemia with Bcl-2 positivity was lower than that of the Bcl-2 negative patients after chemotherapy and the difference between them was significant (OR=0.26, 95%CI 0.14 to 0.46); the difference between acute lymphocytic leukemia and acute non-lymphocytic leukemia in terms of Bcl-2 positive rate was not significant (OR=0.87, 95%CI 0.46 to 1.65); the Bcl-2 positive rate in complete remission (CR) patients after chemotherapy was significantly lower than that of partial remission (PR) and none remission (NR) patients (SMD= –0.87, 95%CI –1.53 to –0.20, P=0.01). Conclution The current domestic evidence proves that Bcl-2 is significantly correlated with the remission rate of acute leukemia patients, but more high-quality studies are still needed.
Objective To detect the difference between the peroxidase (POX) by cytochemical staining and cytoplasm myeloperoxidase (cMPO) by flow cytometry in acute leukemia cells, and provide a more accurate basis for the classification of leukemia. Methods The positive rate of POX in acute leukemia cells was detected by cytochemical staining. The positive rate of cMPO in acute leukemia cells was detected by flow cytometry. Then the positive rate of POX and cMPO, and the positive cells score were analyzed. Results The positive rate and the positive cells scores between POX and cMPO in acute lymphoblastic leukemia were significantly different (P<0.05), the positive rate and the positive cells scores of POX were significantly higher than those of cMPO. The positive rate between POX and cMPO in acute non-lymphoblastic leukemia (ANLL) had significant differences (P<0.05), the positive rate of cMPO was higher than that of POX; but no difference was found between POX and cMPO positive cells scores in ANLL (P>0.05). In acute myelocytic leukemia (AML)-M1 subtype, significant difference was found in the positive rate between POX and cMPO (P=0.006); cMPO positive rate was significantly higher than that of POX, but the POX positive cells score was significantly higher than that of cMPO (P=0.001). There were no significances of positive rate and positive cells score in AML-M2, AML-M3, AML-M4, AML-M5 subtypes between POX and cMPO (P>0.05). Conclusions There are not major differences between positive rate of POX and cMPO, as well as the positive cells scores in acute leukemia, especially acute myelocytic leukemia. We can choose the better method according to the actual situation and the sensitivity requirements. The two methods should be replenished by each other and used alternately.
目的 建立急性白血病（AL）患者八色流式免疫表型分析起始管方案。 方法 用胞膜CD3（CD3）、CD19、CD10、CD34、CD45、胞漿CD79a（cCD79a）、髓過氧化物酶（MPO)和胞漿CD3（cCD3）等8種抗體建立八色流式染色方案。膜表面抗體直接染色；膜內抗體經固定破膜，再染色后上機檢測。將3個血小板減少患者骨髓標本分別進行抗體的單色染色和缺一色染色；最后對17例確診的AL初發患者標本進行檢測。 結果 用單色染色來確定染色方案中各抗體的檢測電壓及熒光補償；缺一色染色中，陽性細胞群較單色染色變化均＜10%，表明方案中的各抗體相互作用小。17例AL初發患者中，6例急性B淋巴細胞白血病原始細胞均為CD34和CD19陽性，5例cCD79a陽性和4例CD10陽性；4例急性T淋巴細胞白血病患者均為cCD3陽性；6例急性髓細胞白血病均為CD34和MPO陽性；1例B+T混合表型AL患者CD34、cCD3、CD19、cCD79a及CD10均為陽性，MPO和CD3為陰性，此檢測方案能夠確定各類AL的細胞類型。 結論 建立了AL患者八色流式免疫表型分析起始管方案，操作簡便快速，適用于臨床檢測。