| 摘要: |
| ［摘要］ 目的 总结分型困难白血病诊断的经验及教训，进一步提高白血病诊治水平。方法 回顾性分析近5年来我科诊治分型困难的白血病患者的骨髓细胞形态学(Morphology,M)与免疫学（Immunology，I）、细胞遗传学(Cytogenetics,c)及分子生物学（Molecular biology，M）分型,即MICM分型的各项检验结果。结果 住院确诊的白血病病人463例，其中10例患者各检验结果出现不完全一致：细胞形态学和免疫学分型诊断为急性早幼粒细胞白血病（AML-M3,APL），而荧光原位杂交技术（fluorescence in situ hybridization，FISH）检查PML/RARa融合基因（-）2例；细胞形态学不能确定分型3例；细胞形态学诊断为急性髓性白血病部分分化型（AML-M2），而免疫学诊断为APL 2例、AML-M2/APL 1例；细胞形态学诊断为慢性粒细胞白血病（CML），而免疫学考虑为急性白血病（AL）1例；细胞形态学诊断为急性髓性白血病未分化型（AML-M1），而免疫学考虑急性髓性白血病未分化型/微分化型（AML-M1/M0）伴随淋巴细胞系表达，FISH BCR/ABL融合基因（+）1例。结论 白血病的MICM分型有时各项结果不尽相同，M2与M3、急性淋巴细胞白血病（ALL）与M0或M1在形态学、免疫学上不易鉴别，需综合分析方能得出正确诊断。 |
| 关键词: 分型困难 白血病 MICM分型 |
| DOI：10.3969/j.issn.1674-3806.2017.04.07 |
| 分类号:R 733.7 |
| 基金项目:广西卫计委科研课题（编号:Z2008057；Z2009133） |
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| Clinical research of difficultly classifed leukemia |
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LIN Jin-ying, WANG Bang-qin, ZHOU Rui-lian, et al.
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Department of Haematology, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To improve the accuracy of diagnosis and treatments of leukemia being hard to define the types of leukemia by using MICM classification.Methods The data of leukemia patients were retrospectively analyzed, whose diseases were difficult to diagnose through MICM(Morphology, Immunology, Cytogenetics, and Molecular biology) classification in the past five years in the People′s Hospital of Guangxi Zhuang Autonomous Region.Results Of the four hundred and sixty-three leukemia patients enrolled in the study, ten cases were difficult to be diagnosed in whom two cases were diagnosed with acute promyelocytic leukemia(AML-M3, APL) by morphology and immunology classification, but the fluorescence in situ hybridization（FISH） of PML/RARα fusion gene was negative, and three cases were unidentified through morphology classification, and two cases were classified as acute promyelocytic leukemia(APL) and one case as acute myeloblastic leukemia with significant maturation or acute promyelocytic leukemia(AML-M2/APL) by immunology classification, but by morphology classification, they were defined as AML-M2; one case showed chronic granulocytic leukemia(CML) on morphology classification, but acute leukemia(AL) on immunology classification; one case was diagnosed with acute myeloblastic leukemia with minimal maturation(AML-M1) by morphology classification, but in immunology classification, it was considered as acute myeloblastic leukemia with minimal maturation or without cytologic maturation(AML-M1/M0) with lymphocytic series expressions, and FISH of BCR/ABL fusion gene was positive.Conclusion Morphology, immunology, cytogenetics, and molecular biology classification of leukemia may lead to different diagnostic results in the same patient. It is hard to define AML-M2 and AML-M3, ALL, AML-M0 and AML-M1 through morphology and immunology classification. It needs comprehensive analysis to diagnose the types of leukemia. |
| Key words: Classification difficulty Leukemia MICM Classification |
