慢性髓细胞白血病急变期MICM分型回顾性分析

目的：探讨慢性髓细胞白血病急变期（CML-Be）患者的细胞形态学（M）、免疫学（I）、细胞遗传学（C）和分子生物学（M）的特征及应用价值。方法：对38例CML．BC患者的MICM分型进行回顾性分析。结果：以FAB分型为基础的形态学确诊率达94．7％;免疫分型结果为：38例CML-BC中CML-AML占71．0％,其中37．0％伴淋系表达;CML-ALL占23．7％,均为B细胞性,其中66．67％伴髓系表达;CML-MAL（混合性白血病）占5．3％,均为B系和髓系混合表达;CD34＋26例（68．4％）,cD7＋10例（26．3％）,均与CD34共表达。细胞遗传学结果显示：CML特征性Ph染色体检出率为94．3％（36／38）,附加异常染色体检出率为60．5％（23／38）,发生频率较高的类型是＋Ph、＋8和i（17q）;FISH检测BCR／ABL融合基因阳性率为100％,der（9）缺失占14．7％。RT—PCR检测20例患者BCR／ABL融合基因均为阳性,其中b2a2型（12／20）,b3a2型（8／20）,1例（1／20）,b2a2和b3a2双阳性（1／20）。结论：CML—BC是造血干细胞疾病,原始细胞分化阻滞在早期阶段,预后差。MICM分型对CML-BC的诊断、治疗和预后判断均有重要价值。     

28例急性巨核细胞白血病实验室检查结果分析

目的:分析急性巨核细胞白血病(AMKL)患者实验室检查特点。方法:4管用8色抗体组合对28例AMKL患者的骨髓有核细胞进行免疫表型分析,同时结合分析患者骨髓细胞形态学、融合基因和染色体核型等检查结果。结果:28例AMKL患者中阳性表达率较高的是巨核细胞相关抗体:CD41a、CD61、CD42b、CD36,阳性率分别为81. 48%、92. 86%、72. 00%、70. 83%,其中,CD41a、CD61、CD42b三种抗体共表达的患者占53. 57%,至少表达两种抗体的患者占82. 14%。髓系祖细胞相关标志:CD117、CD34、CD38、HLA-DR阳性表达率分别为64. 29%、42. 86%、64. 29%和46. 15%,与非APL的AML患者相比表达率均较低(P 0.01);髓系全程抗原CD13、CD33在AMKL中阳性表达率与非APL的AML之间无统计学差异。髓系中后期抗原CD15及单核系抗原CD64、CD14、CD300e和胞浆抗原MPO、cCD79a和cCD3均阴性。与非Down综合征相关AMKL(non-DS-AMKL)相比,CD7与CD11b的表达在Down综合征相关AMKL(DS-AMKL)中较高(P 0.05)。AMKL患者中17例(65.4%)为复杂染色体核型,5例为+21染色体异常;仅5例患者核型正常。25例行白血病融合基因筛查,24例(96%)患者WT1基因表达增高(40.24±59.14%),12例患者(70.58%) EVI1基因表达增高(53.93±37.98%),4例患者融合基因阳性(2例MLL-AF9阳性,1例TLS-ERG,1例P210 BCL/ABL)。结论:AMKL中82.14%患者表达至少两种巨核细胞相关标志,髓系祖细胞标志表达相对较低,多为复杂染色体核型异常,WT1及EVI1异常表达率较高。     

185例儿童急性白血病流式细胞术免疫分型研究

目的:探讨儿童急性白血病流式细胞术免疫分型的意义。方法:采用流式细胞术三色荧光标记技术和CD45/SSC双参数散点图设门,检测185例儿童急性白血病的免疫表型,对抗原表达情况进行分析。结果:流式细胞术免疫分型和FAB分型的符合率为89.19%。185例儿童急性白血病中,ALL为121例,占AL的65.41%,B-ALL为113例,主要表达B系的CD19(99.12%)、CD22(98.13%)、CD79a(96.19%)、CD10(86.73%)。T-ALL占8例;主要表达CD5(100%)、CD7(100%)、cCD3(100%)、CD8(87.5%)。AML为47例,占25.41%,主要表达CD33(93.62%)、CD15(78.72%)、CD64(76.6%)、MPO(76.6%)、CD13(74.47%)。在B-ALL,AML,T-ALL中,敏感性最高的抗体分别是CD19,CD33,CD5和CD7,特异性最强的抗体分别是CD79a,MPO,cCD3。AMLL为17例,占9.19%,其中B/M为9例,T/B为5例,T/M为3例。My十-ALL为54例,占ALL的44.63%,表达的髓系抗原为CD13、CD15、CD33、CD64。Ly+-AML为18例,占AML的38.30%,表达的淋系抗原为CD19、CD4、CD7。系列非相关抗原CD34的表达率为67.57%,HLA-DR的表达率为85.41%,CD38的表达率为80.59%,TdT的表达率为62.59%。结论:流式细胞术免疫分型在白血病分型中起重要作用,是FAB分型的补充和修正,提高了儿童急性白血病诊断的准确率有必要进一步加强流式细胞术免疫分型的标准化工作。     

核型分析与FISH技术诊断成人B细胞急性淋巴细胞白血病等臂双着丝粒费城染色体

目的提高对携带复杂费城染色体(Philadelphia chromosome,Ph)的急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)的鉴别诊断和治疗的认识。方法用染色体核型分析技术对1例成人B细胞ALL(B-ALL)患者骨髓细胞做细胞遗传学检查;核型异常细胞用荧光原位杂交(FISH)进行验证。结果首次发现该B-ALL患者异常细胞系携带等臂双着丝粒Ph,并呈现克隆演化趋势;干系克隆细胞携带典型的Ph,旁系克隆细胞的Ph发生多种演化;FISH检测显示BCR/ABL1融合基因的拷贝数逐步增加。结论成人B-ALL中Ph经复制重排形成等臂衍生Ph非常罕见;这些重排使BCR/ABL1拷贝数增加,可能是导致白血病细胞快速增殖及耐药的机制。     

急性髓系白血病免疫表型特征及遗传学特征分析

目的:研究急性髓系白血病免疫表型特征以及遗传学特征。方法:选取2011年1月到2014年5月我院收治的急性髓系白血病患者169例,采用流式细胞术和相关的单克隆抗体来分析所有患者的骨髓免疫表型,采用染G染色体显带技术分析患者的核型,根据淋系抗原(lym Ag)的表达将患者分为lym Ag+组和lym Ag-组。结果:抗原CD13、CD33、CD117以及MPO等髓系抗原最常在急性髓系白血病患者中表达,其中CD117在M3型病例中表达为85.7%(24/28),而CD34、HLA-DR双阴性、较强的自发荧光、CD13、CD33和MPO对M3型的诊断也具有一定的价值;其中47.9%(81/169)的患者伴随着淋系抗原表达,以CD7和CD56为主;60.4%(102/169)的患者伴随着核型异常;而伴随着t(8:21)的M2患者中的CD15、CD19和CD56的表达显著增强,而t(15:17)均发生于M3型患者中;而lym Ag+组患者CD34的阳性患者为77.8%(63/81)显著高于lym Ag-组的47.7%(42/88),两组比较差异具有统计学意义(P0.05)。结论:免疫表型对急性髓系白血病的诊断具有重要的意义,且免疫表型和异常核型存在密切的联系。     

LCMV-CL13慢性感染小鼠模型的建立及其BCR突变分析

目的 建立淋巴细胞性脉络丛脑膜炎病毒LCMV-CL13慢性感染小鼠模型,分析其作为B细胞受体高频突变研究模型的可能性。方法 C57BL/6N小鼠经尾静脉途径接种2×10⁶ PFU剂量LCMV-CL13病毒,感染后第10、20、30、40、50、60、70天采集样品,通过qPCR检测组织病毒载量,流式检测分析外周血CD4⁺T、CD8⁺T、CD19⁺B细胞及脾生发中心B细胞比例,免疫组库测序分析BCR V区基因丰度及突变率。结果 在LCMV-CL13病毒感染小鼠体内检测到1×10⁶ copies/μL水平的病毒复制;在感染平台期,小鼠外周血CD4⁺T细胞比例逐渐升高(13.15%±0.72%),CD8⁺T细胞先降低(2.17%±0.40%)后逐渐恢复(6.65%±0.52%),CD19⁺B细胞以及生发中心B细胞比例分别增加至(40.32%±0.46%)和(10.03%±0.60%);测序结果证明BCR重链V基因使用频...     

急性B淋巴细胞白血病儿童化疗后微小残留病灶免疫表型改变的分析

目的:分析儿童急性B淋巴细胞白血病(B-cell acute lymphoblastic leukemia,B-ALL)化疗过程中首次微小残留病灶(minimal residual disease,MRD)免疫表型的变化规律及特点,为临床诊断及后续微小残留病的监测提供依据。方法:回顾性分析我院2013年1月至2018年4月收治的393例B-ALL患儿的免疫分型结果及诱导化疗第15天首次MRD数据。结果:(1)在393例白血病中,B-ALL相关特征性免疫表型的出现频率为:CD19+/CD10+/34+64.4%;CD19+/CD10+/34部分表达,15.5%;CD19+/CD34+/CD20+,58.5%;CD19+/CD10+/CD13+,13.2%;CD19+/CD10+/CD33+,5.9%;CD19+/CD10+/CD117+,0.7%;CD19+/CD10+/CD123+,50.1%;CD19+/CD10-/34±,5.9%;CD19+/CD10-/CD20-,2.5%;CD34bright,12.2%;(2)共有285例首次MRD检测结果呈阳性,有181例(63.5%)MRD检测结果至少有1个抗原荧光强度发生改变,其中出现一个抗原强度变化的为83例(29.1%),2个抗原荧光强度变化的为57例(20.0%),3个抗原荧光强度变化为31例(10.9%),4个及4个以上抗原荧光强度变化为10例(3.5%)。抗原荧光强度变化频率最高的依次为CD45、CD34、CD20;(3)共有7例患儿复发,复发时行免疫分型检测,其中4例与初发时有抗原荧光强度变化。结论:(1)儿童B-ALL远高于其他白血病类型,且具有独特的相关特征性免疫表型。初发B-ALL免疫分型结果不仅可完善白血病MICM分型,更是化疗后MRD监测的线索及客观依据;(2)在儿童B-ALL化疗过程中,免疫表型极有可能会发生变化,在后续的微小残留病灶检测过程中应注意对变化抗原的判断和追踪。     

OAZ1基因诱导慢粒白血病K562细胞向成熟红系方向分化

近年来,鸟氨酸脱羧酶抗酶(OAZ)作为肿瘤治疗的潜在靶点备受关注.本文研究了OAZ1基因过表达对慢粒白血病K562细胞红系分化的作用.构建框移位点突变的OAZ1 过表达慢病毒载体pLVX-Neo-OAZ1-IRES-ZsGreen,包装病毒并感染K562细胞, Western 印迹验证其过表达效果.FACS检测细胞分化标志物CD71和GPA,结合联苯胺染色分析细胞红系分化情况.对比氯化高铁血红素(hemin)诱导组,实时RT-PCR检测与K562细胞红系分化、癌变的关键基因(GATA1、BCR/ABL、TGFβ)转录水平,对OAZ1 诱导分化的机制进行初步探索.结果表明,慢病毒过表达载体及K562细胞过表达体系构建成功.OAZ1过表达后细胞红系分化标志物CD71+/GPA+为(11.22±2.09)%,与对照组(4.07±1.04)%、空病毒组(1.79±2.36)%相比差异极显著(P<0.01);联苯胺蓝染阳性率为(14.037±0.083)%,与对照组、空病毒组比较,差异也极显著(P<0.01).定 量分析结果提示,相对于GATA1、BCR/ABL 基因mRNA转录水平的影响,OAZ1对TGFβ 基因的作用更为明显.为此推断,OAZ1基因可诱导白血病K562细胞向成熟红系方向分化,其作用机制可能与TGFβ信号转导通路相关.     

基于量子点荧光共振能量转移（FRET）效应的裂开型CD20核酸适配体探针用于非霍奇金淋巴瘤的检测研究

目的:构建新型的基于量子点荧光共振能量转移效应的裂开型CD20核酸适配体激活式荧光探针用于非霍奇金淋巴瘤(Non-Hodgkin Lymphoma, NHL)的检测。方法:将CD20核酸适配体CE4-1进行裂解,结合量子点和Cy5荧光供受体队之间的FRET效应,利用流式细胞术,对裂开型核酸适配体的裂开位置、比例、浓度和反应时间进行优化,并在最优条件下评估该检测体系对CD20~+细胞的检测特异性。结果:将CD20核酸适配体CE4-1分别裂开成CE4-1-1a/CE4-1-1b和CE4-1-2a/CE4-1-2b两种组合,分别修饰量子点(QD)或荧光受体Cy5后两两组合,分别与CD20~+细胞孵育,流式细胞术发现CE4-1-1a/CE4-1-2b组合时信号最强;进一步,通过探索两种探针比例、探针浓度、孵育时间等参数,发现当CE4-1-1a和CE4-1-2b浓度比例为1:5、CE4-1-1a浓度为4 nM、孵育时间为50 min时,该裂开型核酸适配体体系显示出对靶肿瘤细胞最强的亲和力和FRET信号激活性能。进一步,实验发现该体系与CD20~+细胞(Raji和Ramos)可产生较强信号,而与CD20-细胞(Jurkat、K562、Min6和Hela)均未产生阳性信号,提示该探针可有效保持对CD20~+细胞的高特异性。结论:基于量子点荧光共振能量转移(FRET)效应的裂开型CD20核酸适配体探针体系在检测CD20~+细胞方面表现出了极低的背景信号,同时有着较好的FRET信号值,有望实现CD20~+NHL细胞的高灵敏激活式检测。     

PESV 对K562 细胞BCR/ABL 融合基因及凋亡调控因子Bcl-2、Bad 表达的影响

目的:探讨PESV对K562细胞BCR/ABL融合基因及凋亡调控因子bcl-2和bad表达的影响.方法:将体外培养K562细胞,经PESV处理不同时间后,流式细胞术检测细胞凋亡率,荧光定量RT-PCR检测BCR/ABL、Bcl-2、Bad mRNA水平变化.结果:与对照组相比,PESV处理后K562细胞,凋亡率增加,BCR/ABL融合基因表达降低,抗凋亡相关基因Bcl-2 mRNA表达降低,促凋亡基因Bad mRNA表达增加.结论:PESV能降低降低K562细胞BCR/ABL融合基因的表达,可能通过调节Bcl-2和Bad表达,抑制K562细胞增殖,促进其凋亡.     

ST段抬高性和非ST 段抬高性急性心肌梗死患者的冠状动脉病变特点比较

目的:比较ST段抬高性和非ST段抬高性急性心肌梗死患者的冠状动脉病变特点。方法:选取100例在我院接受24h动态心电图和冠状动脉造影检查的急性心肌梗死患者,根据心电图结果分为观察组和对照组各50例。对照组为ST段抬高性心肌梗死(STEMI)患者,观察组为非ST段抬高性心肌梗死(NSTEMI)患者,比较两组患者冠状动脉病变的差异。结果:对照组LAD(左前降支)闭塞血管比例(52.00%)显著高于观察组(18.00%),差异具有统计学意义(P0.05)。对照组LCX(回旋支)闭塞血管比例(8.00%)显著低于观察组(50.00%),差异具有统计学意义(P0.05)。对照组RCA(右冠脉主干)闭塞血管比例(40.00%)和观察组(30.00%)比较,差异无统计学意义(P0.05)。对照组单支病变比例(46.00%)明显高于观察组(12.00%),对照组三支病变比例(20.00%)明显低于观察组(48.00%)比较,差异均具有统计学意义(P0.05)。对照组二支及正常血管比例与观察组比较,差异均无统计学意义(P0.05)。对照组罪犯血管狭窄程度在76%-90%、91%-99%及完全闭塞的比例与观察组比较差异均具有统计学意义(P0.05)。罪犯血管狭窄程度在50%及50%-75%时,两组差异无统计学意义(P0.05)。两组并发症发生情况比较,差异无统计学意义(P0.05)。结论:1NSTEMI罪犯血管闭塞以LCX多见,STEMI罪犯血管闭塞以LAD多见;2NSTEMI以三支血管病变较多见,STEMI以单支病变较多见。     

Clinical significance of urinary N1,N12-diacetylspermine levels in patients with hepatocellular carcinoma

BACKGROUND/AIM: N1,N12-diacetylspermine (DiAcSpm), a diacetylpolyamine which was recently identified in urine, appeared to be a useful tumor marker for urogenital cancers. Here we examined the clinical significance of urinary DiAcSpm as a tumor marker for hepatocellular carcinoma (HCC). METHODS: Urine samples were collected from patients with HCC and benign liver diseases. Urinary levels of DiAcSpm were measured by ELISA, which was newly developed in order to analyze large numbers of samples. RESULTS: The appropriate threshold value was set at 325 nM/g x creatinine. The sensitivity of the DiAcSpm assay for HCC was 65.5% and the specificity calculated between HCC and liver cirrhosis was 76.0%. The percentage of DiAcSpm-positive HCC patients was similar to that for AFP or PIVKA-II. At more advanced clinical stages, the positive percentage of these three markers increased but the DiAcSpm levels appeared to move independently of AFP and PIVKA-II. In HCC patients, the DiAcSpm levels reflected the progression of disease or the effect of treatment. CONCLUSIONS: DiAcSpm levels were found to reflect the severity, activity or viability of HCC. Urinary DiAcSpm can therefore be considered one of the useful indexes for patients with HCC.     

Correlation of the sperm morphology with the presence of aneuploidies in its nuclei in patients with astheno-, oligo-, and teratozoospermia

An analysis of numerical anomalies of chromosomes 13, 18, 21, X, and Y was carried out using the FISH method before in vitro fertilization in the sperm nuclei of patients with astheno-, oligo, and teratozoospermia. The percentage of aneuploid spermatozoa was significantly higher (p < 0.05) in patients with oligozoospermia compared to patients with astheno- and teratozoospermia. A significant difference in the percentage of spermatozoa that carried a cytoplasmic droplet was revealed in patients with a content of aneuploid sperm of more than 1.0% and less than 0.2%.     

Effects of low-dose tamoxifen on breast cancer biomarkers Ki-67, estrogen and progesterone receptors

Breast carcinoma is the most common malignancy among women and it has a major impact on mortality. Studies of primary chemoprevention with tamoxifen have generated high expectations and considerable success rates. The efficacy of lower doses of tamoxifen is similar to that seen with a standard dose of the drug, and there has been a reduction in healthcare costs and side effects.The immune reaction to monoclonal antibody Ki-67 (MIB-1) and the expression of estrogen receptors (1D5) and progesterone receptors (PgR 636) in breast carcinoma were studied in patients treated with 10 mg of tamoxifen for a period of 14 days.A prospective randomized clinical trial was conducted with 38 patients divided into two groups: Group A: N = 20 (control group-without medication) and Group B: N = 18 (tamoxifen/10 mg/day for 14 days). All patients signed an informed consent term previously approved by both institutions. Patients underwent incisional biopsy before treatment and 14 days later a tumor tissue sample was obtained during surgical treatment. Positivity was quantitatively assessed, counting at least 1.000 cells per slide. For statistical data analysis, a Wilcoxon non-parametric test was used, and α was set at 5%.Both groups (A and B) were considered homogeneous regarding control variables. In Group A (control), there was no statistically significant reduction in Ki-67 (MIB-1) (p = 0.627), estrogen receptor (1D5) (p = 0.296) and progesterone receptor positivity (PgR 636) (p = 0.381).In Group B (tamoxifen 10 mg/day), the mean percentage of nuclei stained by Ki-67 (MIB-1) was 24.69% before and 10.43% after tamoxifen treatment. Mean percentage of nuclei stained by estrogen receptor (1D5) was 59.53% before and 25.99% after tamoxifen treatment. Mean percentage of nuclei stained by progesterone receptor (PgR 636), was 59.34 before and 29.59% after tamoxifen treatment. A statistically significant reduction was found with the three markers (p < 0.001).Tamoxifen significantly reduced monoclonal antibody Ki-67 (MIB-1), estrogen receptor (1D5) and progesterone receptor positivity (PgR 636) in the breast epithelium of carcinoma patients treated with a 10 mg dose of tamoxifen for 14 days.     

Therapeutic efficacy of 3 treatment protocols for non-complicated Plasmodium falciparum malaria, Antioquia, Colombia, 2002

High resistance of Plasmodium falciparum malaria to chloroquine poses malaria as a major public health problem in Colombia. In this context, the therapeutic response of uncomplicated P. falciparum malaria patients to chloroquine (CQ), sulfadoxine/pirymethamine (SDXP) and combined therapy (SDXP/CQ) was evaluated according to the WHO/PAHO protocols of 1998. The comparisons were based on a sample of 160 patients with uncomplicated P. falciparum malaria in Turbo and Zaragoza (Antioquia, Colombia). Patients were randomly assigned each of the treatment categories. The results were statistically similar in each municipality. In Turbo percentage of treatment failure was 87.5%, 22.2% and 22.6% for CQ, SDXP and SDXP/CQ, respectively, whereas in Zaragoza, the corresponding treatment failure was 77.7%, 26.5% and 12.1%. During follow up, 50% of subjects with late treatment failure were asymptomatic in Turbo, while 33.3% were asymptomatic in Zaragoza. A high level of treatment failure occurred with CQ monotherapy, while SDXP and SDXP/CQ had acceptable levels of failure, i.e., below 25%. The high percentage of late treatment failure in asymptomatic patients may contribute to increased risk of persistent transmission.     

Use of monoclonal antibodies as a diagnostic tool in human leukemia. I. Acute myeloid leukemia and acute phase of chronic myeloid leukemia

Various monoclonal antibodies (mAbs) detecting certain different epitopes on myeloid cells (VIMD5, D5 D6, OKM1, Leu-M3, VIEG4, OKIa 1) have been used in combination with conventional markers (antihuman myeloid hetero-antiserum, FcIgG-receptors, C3d-receptors) to further define the phenotypic heterogeneity of myeloid leukemia. Subsequent leukemic samples from previously untreated patients with acute myeloid leukemia (AML) (51 adults, 24 children) and from nine adult patients in the acute phase of chronic myeloid leukemia (CML-BC) were studied. It was possible to demonstrate quantitative differences in the expression of antigens on the various leukemia subtypes which could be exploited for diagnosis. Furthermore our results revealed that there is a very close correlation between the different surface phenotypes and the types morphologically assessed according to FAB-criteria.     

Amoxicillin resistance in Helicobacter pylori: studies from Tokyo, Japan from 1985 to 2003

BACKGROUND: Previous reports revealed no resistant strains of amoxicillin (AMPC), which is usually used in eradication therapy for H. pylori infection. However, the frequency and evolution of natural AMPC-resistant strains in the Japanese population remains unknown. AIM: To assess the prevalence of H. pylori resistance against AMPC in the Tokyo area, a collection of 648 H. pylori strains isolated from patients with GI diseases from 1985 to 2003 was tested for their sensitivity to AMPC. METHODS: The susceptibility of the strains was assessed by determination of the minimal inhibitory concentration (MIC) using the E-test and/or the Dry-plate method. The susceptibility breakpoints of AMPC for H. pylori were: sensitive (AMPC-S); MIC < 0.04 microg/ml, intermittent resistance (AMPC-I); 0.04-1, resistant (AMPC-R); > 1. RESULTS: No AMPC-R strains were detected in the strains isolated between 1985 and 1996, while the rate of resistance was determined to be 1.1%, 2.1%, 5.4%, 5.6%, 0%, 8.8%, and 1.5% every year, respectively, from 1997 to 2003. The percentage of AMPC-I strains increased from 2000 to 2003. The total eradication rate of H. pylori in the patients who received triple therapy containing AMPC was 81.4% (214/263). Classified as above, the rates of AMPC-S, AMPC-I, and AMPC-R were 84.6%, 77.8%, 25%, respectively. CONCLUSION: H. pylori resistance to AMPC is still rare in Japan, although the percentage of AMPC-I strains has increased over the last 4 years. The frequency of isolation of strains showing true resistance to AMPC may increase in the future, along with an increase in the frequency of isolation of AMPC-I strains.