血液分析仪检验急慢性白血病的临床分析

目的:探讨血液分析仪检验急慢性白血病的临床效果.方法:40例白血病患者(慢性白血病6例,急性白血病34例)与健康体检人40例分别采用贝克曼 DxC 600 Synchron型血细胞分析仪进行血液学检验.结果:通过检测分析,急慢性白血病的外周血血红蛋白都低于对照组,而CRP、白细胞值都明显高于对照组,差异有显著性(P>0.05).不过上述指标值在急慢性白血病间差异无显著性(P<0.05).结论:血液分析仪在白血病患者的血液检验效果好,可得到比较准确的诊断结果,值得推广应用.     

白血病干细胞研究的最新进展

髓系白血病是一种具有多分化潜能的异常造血细胞形成的克隆性疾病,以造血干祖细胞的增殖、分化和成熟异常为主要特征.通过对白血病不同亚群进行研究,研究者发现不同群体的白血病细胞功能不同,有学说认为这种异质性是由白血病干细胞(LSC)形成的.近年来,对LSC的研究提示这群细胞与白血病的起病及治疗有十分重要的关系,文章回顾了近期在LSC起源、免疫表型及在白血病细胞群体中的比例等方面的研究进展.     

白血病和淋巴瘤患者ABO血型分布及地区性差异分析

目的 探讨ABO血型与白血病、淋巴瘤的相关性和地区性差异.方法 采用病例对照研究方法,调查不同类型白血病、淋巴瘤患者和健康对照组ABO血型分布特征,分析不同地区白血病、淋巴瘤患者的ABO血型分布情况.结果 急性非淋巴细胞白血病、急性淋巴细胞白血病、非霍奇金淋巴瘤患者的ABO血型分布与健康人群分布差异有统计学意义(χ2=21.23、χ2=8.36、χ2=9.39,均P<0.05).国内不同地区的白血病、淋巴瘤ABO血型分布有差异,其中白血病ABO血型分布差异具有统计学意义(χ2=50.65,P<0.05).结论 ABO血型可能是白血病、淋巴瘤的遗传易感因素,但地理因素可能是主要影响因素之一.     

白血病Flt3基因编码的近膜区点突变的检测和内含子14缺失的分析

目的 对白血病Flt3基因编码的近膜区突变点进行检测,研究其与白血病发生、发展的关系.方法 应用聚合酶链反应(PCR)、聚合酶链反应单链构象多态性(PCR/SSCP)和DNA测序方法,对60例白血病患者外周血和部分骨髓标本Flt3基因外显子14、15进行检测.结果 在60例白血病患者中,3例白血病Flt3-L576P发生点突变,其中1例合并有Flt3基因内含子14缺失突变.结论 白血病Flt3-L567点突变是近膜区(JM)新发现的点突变,其发生与临床白血病的发生、发展具有相关性.     

Bcl-2参与SCID小鼠体内齐墩果酸诱导HL-60细胞凋亡的调控作用

目的:观察齐墩果酸(OA)对白细胞移植模型小鼠脾脏浸润白血病细胞凋亡数量和Bcl-2蛋白表达的影响,探讨OA对白血病模型鼠的治疗作用机制.方法:取浓度为2×107mL-1体外培养的人早幼粒系白血病HL-60细胞0.5 mL,腹腔注射重症联合免疫缺陷(SCID)小鼠,构建SCID小鼠的HL-60细胞移植瘤模型;模型成功后小鼠分为用药组、白血病模型对照组,并设正常对照组.用药组以200 mg·kg-1OA皮下注射,用药2周后观察各组小鼠的一般状态、外周血象及骨髓象白细胞分类情况,病理学检查脾白血病细胞浸润程度,TUNEL方法测定脾浸润白血病细胞凋亡率,免疫组织化学检测HL-60细胞凋亡相关基因Bcl-2蛋白表达率.结果:成功建立SCID小鼠的HL-60细胞移植瘤模型;用药组小鼠体质量[(15.0±0.8) g]明显高于模型组小鼠[(13.9±0.9) g](P<0.01),小鼠生存期[(50.3±5.5) d]明显高于模型组小鼠[(37.1±4.4) d](P<0.01);与模型组比较,用药组外周血白血病细胞有向正常白细胞分化趋势,可见分叶的白血病细胞,骨髓象中幼稚细胞减少,脾浸润情况改善;用药组小鼠脾浸润白血病细胞凋亡率高于模型组(P<0.01),Bcl-2蛋白表达阳性细胞百分率低于模型组(P<0.01).结论:成功建立白血病移植瘤鼠模型;OA可改变白血病移植瘤模型鼠的一般状态,延长生存期;OA通过降低Bcl-2表达可诱导白血病细胞凋亡.     

DLL4、HES1、VEGF-C及VEGFR-2在白血病患者骨髓中的表达及其临床意义

目的 探讨白血病患者骨髓中DLL4、HES1、VEGF-C及VEGFR-2的mRNA表达水平检测的临床意义,为白血病的诊治提供新的思路。方法选取白血病患者59例作为病例组,均根据临床表现、血象、骨髓象、细胞化学染色、细胞遗传学及流式细胞术检查确诊;对照组20例为营养性贫血患者。采用半定量反转录聚合酶链反应( RT-PCR)方法测定DLL4、HES1、VEGF-C、VEGFR-2 mRNA的含量。结果各组初发急性和慢性白血病患者骨髓中DLL4、HES1、VEGF-C、VEGFR-2mRNA的表达与对照组相比均显著升高(P＜0.05)。急性白血病缓解后DLL4、HES1、VEGFR-2的mRNA表达高于对照组( P= 0.041、0.016、0.047)。急性髓系白血病(AML)组DLL4与VEGFR-2、HES1与VEGF-C表达呈正相关(r= 0.424、0.472;P=0.030、0.014);慢性淋巴细胞白血病(CLL)组HES1与VEGF-C表达呈正相关(r= 0.997,P=0.042)。急性白血病伴髓外浸润者VEGF-CmRNA的表达高于不伴髓外浸润者(P=0.022)。AML组VEGF-C mRNA的表达与原始细胞数呈正相关(r=0.315,P=0.024)。结论DLL4、HES1、VEGF-C及VEGFR-2在白血病发病中相互作用,促进白血病发展、转移及浸润,且这些因子在不同类型白血病及髓外浸润中的作用存在差异。     

CD+4CD+25调节性T细胞在小儿急性白血病发病中的作用

目的 观察CD+4 CD+25调节性T(Treg)细胞在急性白血病患儿及非白血病患儿外周血中的变化,研究CD+4 CD+25 Treg细胞在小儿急性白血病发病中的作用.方法 采用流式细胞术检测急性白血病初诊患儿组20例及非白血病患儿对照组20例外周血CD+4 CD+25 Treg细胞的数量及比例.结果 初诊患儿组及对照组外周血CD+4 CD+25 CD-127 Treg细胞占CD+4 T细胞的比例分别为(11.57±1.04)%和(6.75±0.75)%,在初诊患儿组高于对照组(t=16.808,P<0.001).结论 急性白血病患儿外周血中CD+4 CD+25 CD-127 Treg细胞数量升高,提示CD+4 CD+25 Treg细胞可能在白血病的发生、发展中起一定作用.     

急性嗜酸性粒细胞白血病一例临床特点分析

目的 研究急性嗜酸性粒细胞白血病临床特点,结合文献探讨急性嗜酸性粒细胞白血病的诊断及鉴别诊断.方法 报道1例病例并运用实验室检查、骨髓细胞形态检查结合临床表现分析急性嗜酸性粒细胞白血病临床特点.结果 白细胞正常,轻度贫血,血小板减少,外周血及骨髓嗜酸性细胞明显增多日.左移,骨髓原始细胞增多.结论 急性嗜酸性粒细胞白血病临床表现不典型,外周血白细胞不增高,根据骨髓细胞形态可诊断.     

增强子结合蛋白C/EBPα对白血病BALB/c裸鼠的肿瘤抑制作用

目的 探讨增强子结合蛋白C/EBPα在白血病裸鼠体内的肿瘤抑制作用.方法 将30只BALB/c裸鼠随机分转染组(10只)、空载组(10只)、对照组(10只),建立皮下瘤模型,并将30只BALB/c裸鼠如上分组建立白血病模型,将C/EBPα稳定表达细胞株pEGFP-C/EBPα-K562、空载细胞株pEGFP-K562及白血病细胞株K562分别经皮下和尾静脉注射到相应组裸鼠体内,形成皮下瘤和血液病模型.观测皮下肿瘤的变化,应用TUNEL检测细胞的凋亡,瑞特-吉姆萨染色观察血液病模型裸鼠外周血和骨髓中白血病细胞增殖能力,RT-PCR检测增殖相关基因的表达.结果 皮下瘤模型中pEGFP-C/EBPα-K562组肿瘤质量及最大直径为(24±0.1)g和(11±2)mm,空载组和对照组分别为(5.1±0.3)g、(19±3)mm和(5.7±0.4)g、(23±3)mm(均P＜0.05),TUNEL检测发现pEGFP-C/EBPα-K562组肿瘤细胞凋亡明显增加(P＜0.05);血液病模型鼠外周血可见白血病细胞,pEGFP-C/EBPα-K562组白血病细胞增殖能力明显低于空载组和对照组,可见明显细胞分化现象,RT-PCR检测发现p53基因上调和c-myc基因下调.结论 增强子结合蛋白C/EBPα在白血病小鼠体内具有促进肿瘤细胞凋亡和抑制白血病细胞增殖的能力,并能促进白血病细胞分化.C/EBPα的白血病抑制作用可能是通过对相应基因的调控来实现.     

日本发现有助于治疗白血病的关键蛋白

日前美国一项研究报告说,日本研究人员发现了代号为CD96的蛋白,可作为识别导致最常见的成人急性白血病的恶性干细胞活动的标志,从而在寻求根治白血病的方法上迈出关键一步。报告说,急性成髓细胞性白血病(AML)是血液和骨髓的癌症,因单独使用药物常常无     

Leukemia cutis. Fine needle aspiration findings

OBJECTIVE: To aspirate, for cytologic study, skin nodules from known cases of leukemia during full remission. STUDY DESIGN: The study group consisted of nine leukemia patients in full remission who developed skin nodules on the head, face, chest and upper extremities. RESULTS: The size of the nodules ranged between 1 and 3.5 cm. The nodules were aspirated with 21-gauge needle. Four were diagnosed as acute lymphoblastic leukemia, 1 as chronic lymphocytic leukemia, 1 as acute myeloblastic leukemia, 2 as acute monocytic leukemia and 1 as acute promyelocytic leukemia. Histologic sections were diagnosed as lymphoma-leukemia. The patients developed leukemia again three to four months after excision of the skin nodules. CONCLUSION: Fine needle aspiration cytology is useful in the diagnosis of leukemia cutis.     

Who are the Irmas and what are the narratives?

One of the most serious possible consequences of cancer therapy is the development of a second cancer, especially leukemia. Several distinct subsets of therapy-related leukemia can be distinguished currently. These include classic therapy-related myeloid leukemia, leukemia that follows treatment with agents that inhibit topoisomerase II, acute lymphoblastic leukemia, and leukemias with 21q22 rearrangements or inv(16) or t(15;17). These types of leukemia are discussed in detail in this article.     

Transient leukemia followed by megakaryoblastic leukemia in a child with mosaic Down syndrome

A case is presented of a child with mosaic Down syndrome, who presented at birth with a transient leukemia and later progressed to megakaryoblastic leukemia. Evidence is presented that both leukemias were of megakaryoblastic lineage and evolved from a trisomic hematopoietic precursor. This case is unique in the poor course of the initial transient neonatal leukemia with improvement following chemotherapy. It also highlights the form of leukemia and associated myelodysplasia that occurs in children with Down syndrome. This form of leukemia and transient leukemia are interrelated and are unique to children with Down syndrome.     

Leukemia cutis

Leukemia cutis is an uncommon manifestation of leukemia that is strongly associated with the presence of extramedullary disease at other sites. Patients usually present with leukemia cutis concomitantly with systemic leukemia or after leukemia has been diagnosed. Acute monocytic, myelomonocytic, and the T-cell leukemias show the highest incidence of leukemia cutis. The lesions show varied morphology and can be difficult to distinguish both clinically and histopathologically from nonspecific cutaneous lesions, which occur much more frequently. Immunohistochemistry is useful in making the distinction between them. The prognosis in leukemia cutis is generally poor; the best results have been achieved with a combination of systemic and local therapy.     

A histometrical study on the long bones of raccoon dogs, Nyctereutes procyonoides and badgers, Meles meles

In June 1994, a 39 year-old male with adult T-cell leukemia was admitted to our hospital and received combination chemotherapy including epipodophyllotoxin for approximately 1 year. The monocyte count increased gradually beginning in April 1995, accelerating to 100 x 10(9)/l in January 1996, when he was diagnosed with acute monocytic leukemia. Inv(11)(q21;q23) x 2 was recognized at that time by chromosome analysis, and rearrangement of the MLL gene was shown by Southern blot analysis. From the clinical course and subsequent examinations, the case was regarded as epipodophyllotoxin-related secondary leukemia. Recently, epipodophyllotoxin has frequently been used as a treatment agent for adult T-cell leukemia. It is valuable to note that secondary leukemia may follow even such an aggressive leukemia as adult T-cell leukemia.     

The dual-function hamster receptor for amphotropic murine leukemia virus (MuLV), 10A1 MuLV, and gibbon ape leukemia virus is a phosphate symporter

Previously, we showed that the amphotropic receptor homolog in hamster cells functions as a receptor not only for amphotropic murine leukemia viruses and 10A1 murine leukemia virus but also for gibbon ape leukemia virus (C.A. Wilson, K. B. Farrell, and M. V. Eiden, J. Virol. 68:7697-7703, 1994). Here, we demonstrate that this receptor functions as a sodium-dependent Pi transporter and that Na-Pi uptake can be specifically blocked following infection with either amphotropic murine leukemia virus, 10A1 murine leukemia virus, or gibbon ape leukemia virus.     

慢性粒—单核细胞白血病合并Sweet综合征转化为急性白血病一例并文献复习

目的 提高对慢性粒—单核细胞白血病(CMML)合并Sweet综合征的认识。方法回顾性分析1例CMML合并皮肤疱疹患者资料,取皮肤活检进行病理检测,并给予DA、CAG方案等化疗。结果病理诊断为CMML合并Sweet综合征,单用皮质激素治疗效果不佳,CAG方案使CMML获得完全缓解,皮疹得到有效控制。3个月后Sweet综合征复发,CMML进展为急性单核细胞白血病。结论CMML合并Sweet综合征罕见,高度提示短期内进展为急性白血病。     

Acute leukemia during reproductive life: its course, complications and sequelae for fertility

Acute leukemia is less common during the reproductive years than in children or in post-menopausal women. Effective chemotherapy exists for adult lymphocytic leukemia, and the median survival is 18 to 20 months. Acute myelogenous leukemia still has a less favorable prognosis, with a medial survival of 12 months despite effective chemotherapeutic agents. The occurrence of acute leukemia in pregnancy does not change the overall prognosis, which depends primarily on the cytopathologic types. If leukemia occurs during the first trimester, therapeutic abortion is advised since the rate of spontaneous abortion after chemotherapy is high in the first trimester and fetal malformations are common. Acute leukemia can be treated in the second and third trimesters with little effect on the pregnancy or fetus. In patients cured of acute leukemia, the potential for subsequent pregnancies exists with little likelihood of increases in fetal malformations.     

Plasma alkaline phosphatase and pregnancy outcome

To investigate the change in adult T-cell leukemia incidence between 1983 and 1992 and to evaluate the sensitivity of the nationwide adult T-cell leukemia survey, we estimated adult T-cell leukemia incidence in the Kyushu district, southern Japan, where adult T-cell leukemia is endemic. The incidence of adult T-cell leukemia was calculated from the difference between Kyushu and the rest of Japan in mortality from malignant lymphoid neoplasms, i.e., Kyushu's excess rate was assumed to be due to adult T-cell leukemia. In Kyushu, average annual adult T-cell leukemia cases aged > or = 20 years were estimated for men as 252 during the period 1983-87 and 341 during 1988-92, and for women as 201 and 246 respectively. The age-adjusted mortality rate tended to be higher in the latter period [6.29 per 100000 (95% confidence interval 5.59-7.00) vs. 5.25 (4.60-5.90) in men, and 3.33 (2.85-3.80) vs. 3.18 (2.71-3.66) in women]. By contrast, the registered number of adult T-cell leukemia cases nationwide during 1988-93 was only 35% (203/587) of the estimated number, and the number of registered versus estimated cases decreased with age, especially when cases were > 60 years old. In conclusion, the estimated adult T-cell leukemia incidence for 1983-92 increased in the latter half of the period. The estimation suggests that 65% of adult T-cell leukemia cases might be missed by a nationwide survey, and older cases were more likely than younger ones to be missed.