Szerafin László, Jakó János, Riskó Ferenc, Hevessy Zsuzsanna
Jósa András Oktatókórház Egészségügyi Szolgáltató Nonprofit Kft. Hematológiai Osztály Nyíregyháza Szent István.
Orv Hetil. 2012 Nov 4;153(44):1732-7. doi: 10.1556/OH.2012.29477.
Smudge cells (Gumprecht shadows) are chronic lymphocytic leukaemic cells ruptured during peripheral blood smear preparation. It has been demonstrated to be linked to reduced expression of the cytoskeletal protein vimentin and its inverse correlation with the clinical outcome of the disease.
Investigation of the percentage of smudge cells, CD38-, ZAP-70-positive cells and the time to treatment in patients with chronic lymphocytic leukaemia.
Authors investigated the percentage of smudge cells, CD38- and ZAP-70-positive cells in the peripheral blood of 50 patients with chronic lymphocytic leukaemia and their correlation with the time to treatment.
21 patients required treatment in the follow-up period. Their median smudge cell percentage was 9.9%, while it was 26.8% in the non-treated group. The cut-off value of smudge cell positivity was set to 20%. 59.3% of the patients with less than cut-off had to be treated in the follow-up time compared to 21.7% of patients with more smudge cells. These findings were similar to the prognostic value of CD38 and ZAP-70. The necessity of treatment increased to 75-77.8% with the combination of investigated markers. The time to treatment was 19 months when smudge cells were less than 20%, but above 20% it was 36.15 months. In case of low smudge cell percentage and CD38 positivity the time to treatment was 14.14 months and in case of high smudge cell percentage and CD38 negativity it was 32.92 months. In discordant cases the time to treatment was 18.43 months. The authors also present a case report that demonstrates the relationship between the percentage of smudge cells and apoptotic cells with annexin V and 7-AAD staining.
Estimation of smudge cells on a blood smear could be a simple and cheap prognostic test in chronic lymphocytic leukaemia with sensitivity similar to CD38 and ZAP-70 estimation. Combination of these tests raised the sensitivity of their prognostic value.
涂抹细胞（贡普雷希特影细胞）是外周血涂片制备过程中破裂的慢性淋巴细胞白血病细胞。已证明其与细胞骨架蛋白波形蛋白表达降低有关，且与疾病的临床结局呈负相关。
研究慢性淋巴细胞白血病患者中涂抹细胞、CD38阳性细胞、ZAP-70阳性细胞的百分比以及开始治疗的时间。
作者调查了50例慢性淋巴细胞白血病患者外周血中涂抹细胞、CD38阳性细胞和ZAP-70阳性细胞的百分比及其与开始治疗时间的相关性。
21例患者在随访期间需要治疗。他们的涂抹细胞百分比中位数为9.9%，而未治疗组为26.8%。涂抹细胞阳性的临界值设定为20%。涂抹细胞低于临界值的患者中有59.3%在随访期间需要治疗，而涂抹细胞较多的患者中这一比例为21.7%。这些发现与CD38和ZAP-70的预后价值相似。联合检测这些标志物时，治疗的必要性增加到75%-77.8%。涂抹细胞低于20%时开始治疗的时间为19个月，但高于20%时为36.15个月。涂抹细胞百分比低且CD38阳性时，开始治疗的时间为14.14个月；涂抹细胞百分比高且CD38阴性时，为32.92个月。不一致的情况下，开始治疗的时间为18.43个月。作者还展示了一份病例报告，该报告通过膜联蛋白V和7-氨基放线菌素D染色证明了涂抹细胞百分比与凋亡细胞之间的关系。
血液涂片上涂抹细胞的评估可能是慢性淋巴细胞白血病一种简单且廉价的预后检测方法，其敏感性与CD38和ZAP-70评估相似。这些检测方法的联合提高了其预后价值的敏感性。
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