28例伴骨髓侵犯非霍奇金淋巴瘤的细胞遗传学分析

Clinical feature and cytogenetic analysis of 28 patients with bone marrow invasion non-Hodgkin lymphoma

目的 研究伴骨髓侵犯的非霍奇金淋巴瘤的血液形态学、骨髓细胞遗传学、临床生化肿瘤指标与预后的相互关系.方法 常规骨髓穿刺法对患者进行骨髓细胞形态学分析,应用骨髓短期培养法制备染色体标本,用R显带技术对28例患者进行核型分析.应用荧光原位杂交(fluorescence in situ hybridization,FISH)技术对患者P53基因进行检测.对所有患者进行血清乳酸脱氢酶值的比较分析.结果 28例患者中,骨髓形态学均显示为淋巴瘤骨髓侵犯,染色体分析发现异常核型19例,发生率67.85%(19/28).异常核型组骨髓中淋巴瘤细胞比例高于正常核型组(60.2% vs.33.5%,P<0.05).经FISH检测发现伴P53基因缺失患者9例,发生率32.14%(9/28).P53基因在异常核型组的缺失率高于正常核型组(42.11% vs.11.11%,P<0.05),伴异常核型的患者其血清乳酸脱氢酶含量显著高于正常核型组[(1464.37 vs.294.33) U/L,P<0.05].结论 核型异常组的患者有较高的P53基因缺失率,其乳酸脱氢酶均值也明显高于正常核型组,其预后也相对较差.

Objective To study the correlation between hematomorphology,bone marrow cytogenetics,clinical biochemical parameters and prognosis of non-Hodgkin's lymphoma with bone marrow invasion.Methods Morphological analysis of bone marrow cells was performed by routine bone marrow puncture.Chromosome samples were prepared by short-term bone marrow culture.Karyotype analysis was carried out by R-banding in 28 patients.P53 gene was detected by fluorescence in situ hybridization(FISH).Serum lactate dehydrogenase(LDH)of all patients was determined and compared.Results In all patients,bone marrow morphology showed bone marrow invasion of lymphoma.Chromosome analysis revealed abnormal karyotypes in 19 cases,which yielded an incidence of 67.85%.The proportion of lymphoma cells in bone marrow among those with an abnormal karyotype was much higher than those with a normal karyotype(60.2%vs.33.5%,P<0.05).FISH assay showed that 9(32.14%)patients had P53 gene deletion.And the deletion was much more common among those with an abnormal karyotype(42.11%vs.11.11%,P<0.05).The serum LDH level in patients with an abnormal karyotype was significantly higher compared with whose with a normal karyotype(1464.37 U/L vs.294.33 U/L,P<0.05).Conclusion Patients with abnormal karyotypes have a higher rate of P53 gene deletion,and their LDH level is significantly higher than those with a normal karyotype,which predicted a relatively poor prognosis.