急性白血病诊治医学ppt

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1、急性白血病诊治进展白血病由于造血祖细胞在增殖发育过程中发生了一系列基因的改变，从而使得造血祖细胞增殖失去了调控，并分化发生停滞，大量的原始造血细胞积聚在骨髓和外周血中，抑制了正常造血细胞的生长，逐渐取代了造血组织。PluripotentialstemcellsMyeloidstemcellsLymphoidstemcellsUnipotentialprogenitorcellsImmaturehematopoieticcellsmaturehematopoieticcellsHematopoiesiscompos

2、esoftheoptionsofcommitmenttodifferentlineagesandtheprogressivestagesofmaturationatwhichpartialorcompletearrestcanoccur,resultsinthewidearrayofmalignantdisease-LeukemiaStemcellProgenitorcellImmaturecellMaturecell临床表现（Clinicalmanifestations）Leukemichematopoiesi

3、sNormalhematopoiesis骨髓造血受抑marrowfailure白血病增殖浸润InfiltrationMyelogenousversuslymphocyticleukemiaIftheleukemiccellsarisefrommyeloidpluripotentialstemcells:myeloidleukemiaIftheleukemiccellsarisefromlymphocyticpluripotentialstemcells:lymphocyticleukemia粒系granulocy

4、ticlineage单核/巨噬系(monocytic/maceophagelineage)红系巨核系(Megakaryocyticlineage)肥大细胞系（mastcelllineages)淋巴细胞肥大细胞单核/巨噬细胞红系细胞巨核细胞粒系：嗜中性、嗜酸性、嗜碱性细胞“髓系”的界定（骨髓产生的)目前存在的分类体系FAB分类：形态学、细胞化学WHO分类：分子遗传学、免疫学、细胞形态学、临床治疗效果和预后MIC分类：形态学、免疫学、细胞遗传学白血病的诊断方法优点：廉价、简便缺点：除M3（APL）和M4Eo外对预后的

5、指导意义小。ThesmearsfromperipheralbloodorbonemarrowstainedwithWright-GiemsaorMay-GrünwaldGiemsaMorphologicdiagnosistechnique:过氧化物酶染色Perioxidase(POX)苏丹黑B染色Sudan/blackB(SB)中性粒细胞碱性磷酸酶染色neutrophilicalkalinephosphatase(NAP)特异性酯酶/氟化钠抑制试验SpecificEsterase(SE)stainwithnaph

6、tholAS-Dchloroacetate(N-ASD-CA)orα-naphtholacetate(ANA)+NaF糖原染色或过碘酸-Schiff反应Periodicacid-Schiff’sReaction(PAS)酸性磷酸酶染色Acidphosphatase(ACP)铁粒幼细胞染色Sideroblaststain细胞化学染色（CytochemicalStain)细胞化学染色图示：SB单克隆抗体流式细胞仪的应用（1953-1968-1971）1982年CD（clusterofdifferentiationor

7、disignation)分子CesarMilsteinNielsK.JerneGeorgesJ.F.Kohler1984NobelPrizewinner细胞免疫表型（immunophenotype)Fig1.AnalysisofnormalandleukemicbonemarrowbyCD45-sidescatteranalysis.(A)Normalmarrowillustratingseveralnormalpopulations.(B)LymphoblastsasseeninALL.(C)TreatedCM

8、Lillustratingtransitiontoacutephasewithincreasedmyeloblastsandareactiveincreaseinerythroidprecursors.(D)Low-gradelymphoproliferativedisorderillustratedbyCLL.Thesepatternsarerepresentative