CD38表达在侵袭性B细胞淋巴瘤诊断中的价值

Bright CD38 expression by flow cytometric analysis in diagnosis of aggressive B cell lymphomas

目的:探讨CD38表达在侵袭性B细胞淋巴瘤诊断和鉴别诊断中的意义。方法:应用多参数流式细胞术检测102例初发侵袭性B细胞淋巴瘤[主要包括弥漫大B细胞淋巴瘤(DLBCL)73例、Burkitt淋巴瘤7例和高级别B细胞淋巴瘤22例]患者淋巴结或骨髓标本中流式免疫标记物的表达情况,比较CD38在各组患者肿瘤细胞上表达水平的差异,分析其在侵袭性B细胞淋巴瘤鉴别诊断中的特点。结果:3组患者肿瘤细胞膜表面CD5、CD19dim、CD20dim和CD45dim表达水平差异无统计学意义(均P>0.05),CD10表达水平以及缺乏免疫蛋白轻链表达差异有统计学意义(P=0.029,P=0.043);将DLBCL分为MYC-R+和MYC-R-患者,CD38+、CD38++和平均荧光强度在DLBCL MYC-R+、DLBCL MYC-R-、Burkitt淋巴瘤和双重/三重打击淋巴瘤4组患者肿瘤细胞表达水平差异有统计学意义(均P<0.05),CD38+在诊断这4组侵袭性B细胞淋巴瘤时除DLBCL MYC-R+外特异性可达100%,但敏感性较低;CD38++诊断DLBCL MYC-R+时特异性可达100%,敏感性低至13%,而诊断Burkitt淋巴瘤和双重/三重打击淋巴瘤时敏感性则明显升高(分别为86%和79%)。结论:CD38不同表达水平在侵袭性B细胞淋巴瘤鉴别诊断中具有重要作用,尤其CD38高表达可以及时准确地早期诊断双重/三重打击淋巴瘤,对临床治疗具有指导意义。

Objective:To investigate the expression level and clinical significance of CD38 in the diagnosis of aggressive B cell lymphomas.Method:Several cytometric markers were detected in the lymph nodes and bone marrows by flow cytometry in 102 newly diagnosed aggressive B cell lymphoma patients,including 73 patients with diffuse large B-cell lymphoma(DLBCL),7 patients with Burkitt lymphoma(BL)and 22 patients with high-grade B cell lymphoma.We compared the expression levels of CD38 on the lymphoma cells in each group,and further analyzed the significance of CD38 expression in the differential diagnosis among aggressive B cell lymphomas.Result:Of the flow cytometric parameters assessed,the expression levels of CD5+,CD19dim+,CD20dim+and CD45dim+showed no statistically significant differences among three groups(P>0.05).Significant differences were observed in expression of CD10+and lacking surface immunoglobulin light chain among these three groups(P=0.029,P=0.043).Bright CD38 expression(CD38+),very bright CD38 expression(CD38++)and median fluorescence intensity of CD38 showed statistically significant differences among four groups including DLBCL MYC-R+,DLBCL MYC-R-,BL and DHL/THL patients.CD38+diagnosed these aggressive B cell lymphomas except for DLBCL MYC-R+with very high specificities(100%)and very low sensitivities.The specificity of CD38++in the diagnosis of DLBCL MYC-R+was 100%and the sensitivity was low to 13%,while CD38++was a significant diagnostic biomarker associated with BL and DHL/THL with higher sensitivities(86%and 79%,respectively).Conclusion:Different expression levels of CD38 could play an important role in the differential diagnosis among aggressive B cell lymphomas,especially bright CD38 expression(CD38+)might early and accurately diagnose DHL/THL and help to guide clinical treatment.