摘要
目的：通过对本组病例研究，提高对WHO分型诊断标准的认识。方法：选择2004-2005年在我院确诊的307例急性髓系白血病（AML），以形态学、免疫表型、融合基因等检测进行分析探讨。结果：按WHO分型诊断标准有14例原始细胞在20％～30％之间的患者被确诊为AML。免疫表型在髓系白血病中MPO、CD13、CD33表达最强，分别为96．77％、94．67％、91．53％。对M0的诊断有特异性，CD34、CD33达99％以上。融合基因检测：AML-M2b中90％以上AML1／ETO融合基因阳性，提示t（8；21）（q22；q22）易位。AML-M3中89．28％PML／RARα融合基因阳性，提示t（15；17）（q22；q12）易位。AML-M4EO中85％的CBFβ／MYH11融合基因阳性，提示inv（16）（p13；q22）。结论：WHO分型标准综合了传统的形态学分型，加入免疫学，融合基因等检测技术，结合临床特点等信息对AML进行分型，提高了对AML的诊断符合率。与FAB相比，更具有完全性、合理性、科学性，是AML分型的发展方向。
Objective ：To improve the cognition to WHO classification diagnosis through the cases study of this group. Methods：We chose 307 cases of first-diagnosed acute myeloid leukemia （AML） patients in the Second Affiliated Hospital of HeBei Medical University in 2004-2005 to analyze by cytomorphological method, immunophenotyping and screening of fusion genes. Results： According to WHO classification,14 cases were diagnosed as AML, with blast cells between 20% and 30%. In AML, the highest expressions were immunophenotype MPO,CD13 and CD33,it was 96.77% ,94.67%and 91.53% respectively. It had specificities to the diagnosis of M0, and CD34, CD33 were more than 99%. Screening of fusion genes： In AML-M2b, more than 90% cases had fusion genes AML1/ETO positive, which showed the reciprocal translocation t （8;21） （q22;q22）. In AML-M3,about 89.28% cases had fusion genes PML/RARα positive, which showed the reciprocal translocation t （15 ; 17） （q22 ;q12） . In AML-M4EO ,about 85% cases had fusion genes CBFβ/MYH11 positive, which showed inv（16）（p13;q22）. Conclusion： The WHO classification improves the diagnosis coincidence rate to AML which integrates with detection techniques such as traditional morphological type, immunology, fusion genes, etc., and combines clinical aspects. Compared with FAB classification, it＇s the developing direction of AML dividing type which has perfectibility, rationality and scientificalness.
