恶性淋巴瘤患者外周血肿瘤浸润检测及其临床意义

DETECTION OF LYMPHOMA CELL INFILTRATION IN PERIPHERAL BLOOD FROM PATIENTS WITH MALIGNANT LYMPHOMA AND ITS CLINICAL SIGNIFICANCE

探讨恶性淋巴瘤（ＭＬ）患者外周血肿瘤浸润（ＩＰＢ）检测方法及与临床分期和疗效的关系。方法以克隆性ＩｇＨ和ＴＣＲγ基因重排分别作为Ｂ和Ｔ细胞淋巴瘤克隆基因标志，应用聚合酶链反应（ＰＣＲ）基因扩增技术，检测２１例外周血形态学，检查ＭＬ患者ＩＰＢ。结果１．２１例ＭＬ患者外周血标本，ＩｇＨ阳性率５２．４％（１１／２１），ＴＣＲγ阳性率４２．９％（９／２１），双阳性率（ＩｇＨ和ＴＣＲγ均阳性）３３．３％（７／２１）。ＩＰＢ检出率为６１．９％（１３／２１）；２例霍奇金氏病（ＨＤ）和１０例非淋巴系肿瘤外周血ＩＰＢ均阴性；２．Ⅲ、Ⅳ期ＭＬ患者ＩＰＢ检出率显著高于Ⅱ期（Ｐ＜０．０５），初诊未治及复发患者也显著高于部分或完全缓解患者（Ｐ＜０．０５）。结论ＰＣＲ方法检测ＩＰＢ有助于估价ＭＬ患者克隆起源、病情、疗效，其敏感性明显高于常规形态学方法。

Objective:Investigating the detection of lymphoma cell infiltration in peripheral blood(IPB) from patients with malignant lymphoma(ML) and the association of IPB with clinical stage and therapeutic effect.Methods:Clonal IgH and TCRγ gene rearrangements were used as gene markers for B and T lymphoma cells respectively; polymerase chain reaction(PCR) was utilized to detect the IPB.Results:1.Among 21 ML cases, 13(61.9%) had a positive IPB,11(52.4%)had a positive IgH,and 9(42.9%)had a positive TCRγ. No IPB was detected in 2 cases of Hodgkin′s disease (HD) and 10 cases of non lymphoid neoplasms.2. The incidence of IPB in stage Ⅲ and Ⅳ patients was higher than that in stage Ⅱ( P <0 05), and was higher in pretreatment and recurrent cases than in partial and complete remission( P <0.05).Conclusions:Detection of IPB by PCR method was sensitive than morphological method, and may provide important information for studying clonal origin of ML and assessing severity of disease and therapeutic effect.