Jiang Neng-Gang, Zhu Huan-Ling, Zeng Ting-Ting, Su Jun, Zhang Yao, Jia Yong-Qian
Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2010 Jul;41(4):664-8.
To evaluate the value of flow cytometric immunophenotyping of cerebrospinal fluid (CSF) cells in the diagnosis of central nervous system leukemia.
Ninety two CSF samples were analyzed with 4-color flow cytometry. Antibody panles CD19/CD34/CD3/CD45, CD117/CD34/CD5/CD45, CD7/CD34/ CD19/CD45, CD7/CD3/HLA-DR/CD45, CD20/CD10/CD3/CD45, and anti-g/anti-lambda/CD19/CD45 were used in determining cell composition and detecting abnormal cells. The results of flow cytometry were compared with conventional cell count and morphology. Flow cytometry analysis was repeated for five samples 48 hours after the initial test.
Abnormal cells were found in 33 out of the 92 (35.9%) samples. Among the 59 samples taken from patients with lymphocyte neoplasm, CD19 + blast cells were found in the CSF in 13 patients with B-cell lymphoblastic leukemia; CD7+ blast cells were found in 4 T-ALL cases; and monoclonal CD19+ cells were found in 6 other types of lymphoma cases. In the 32 patients with clinically diagnosed myeloid leukemia, CD117+ myeloid cells were found in the CSF of 7 patients and B cell blast cells were found in 2 CML cases. The abnormal cells in the CSF detected by immunophenotyping decreased significantly 48 hours after the initial test. Abnormal cells were detected in 25 samples (27.2%) by morphology, less than those detected by immunophenotyping. The cell concentrations of the eight samples in which abnormal cells were only detected by flow cytometry were lower than 10 X 10(6)/L. The immunophenotyping results of two ALL patients were still positive when morphologic results had become negative after chemotherapy.
Flow cytometric analysis of CSF may be helpful in the diagnosis of meningeal leukemia. It has higher positive rate and better accuracy than cytomorphology and cell count.
评估脑脊液（CSF）细胞流式细胞术免疫表型分析在中枢神经系统白血病诊断中的价值。
采用四色流式细胞术分析92份脑脊液样本。使用抗体组合CD19/CD34/CD3/CD45、CD117/CD34/CD5/CD45、CD7/CD34/CD19/CD45、CD7/CD3/HLA-DR/CD45、CD20/CD10/CD3/CD45以及抗κ/抗λ/CD19/CD45来确定细胞组成并检测异常细胞。将流式细胞术的结果与传统细胞计数和形态学结果进行比较。对5个样本在初次检测48小时后重复进行流式细胞术分析。
92份样本中有33份（35.9%）发现异常细胞。在取自淋巴细胞肿瘤患者的59份样本中，13例B细胞淋巴细胞白血病患者的脑脊液中发现CD19 +原始细胞；4例T细胞急性淋巴细胞白血病（T-ALL）病例中发现CD7+原始细胞；6例其他类型淋巴瘤病例中发现单克隆CD19+细胞。在32例临床诊断为髓系白血病的患者中，7例患者的脑脊液中发现CD117+髓系细胞，2例慢性粒细胞白血病（CML）病例中发现B细胞原始细胞。初次检测48小时后，免疫表型分析检测到的脑脊液中的异常细胞显著减少。形态学检测到25份样本（27.2%）存在异常细胞，少于免疫表型分析检测到的数量。仅通过流式细胞术检测到异常细胞的8份样本的细胞浓度低于10×10⁶/L。两名急性淋巴细胞白血病（ALL）患者化疗后形态学结果变为阴性时，免疫表型分析结果仍为阳性。
脑脊液流式细胞术分析可能有助于脑膜白血病的诊断。其阳性率高于细胞形态学和细胞计数，准确性更好。
