免疫球蛋白重链基因重排对多发性骨髓瘤的研究及应用价值

Study and Application of Immunoglobulin Heavy Chain Gene Rearrangement in Multiple Myeloma

为探讨免疫球蛋白重链（IgH）基因重排在浆细胞增殖性疾病中的应用价值，用聚合酶链反应（PCR）技术以10例正常人骨髓标本为对照，对57例多发性骨髓瘤（MM）、11例未定性单克隆丙种球蛋白病（MGUS）、10例反应性浆细胞增多症进行了IgH基因重排的研究。MM的外周血和骨髓的IgH基因重排检出率分别为56．9％及84.4％。外周血IgH基因重排的分析显示Ⅱ、Ⅲ期患者检出率高于Ⅰ期。经化疗后缓解的病例其骨髓标本，仍可检出重排带。MGUS及反应性浆细胞增多症均未能测出IgH基因重排。本结果表明：IgH基因重排对MM的诊断、鉴别诊断及指导治疗有重要意义。

In order to study the applicable yalue of immunoglobulin heavy chain (IgH) gene rearrangement in plasma cell disorders. IgH gene rearrangement was studied with polymerase chain reaction in 57 patients with multiple myeloma (MM ), 11 patients with monoclonal gammopathy of undeterminecl significance (MGUS), 10 patients with reactive plasmacytosis and 10 normal subjects as control.The positive rate of IgH gene rearrangement in the peripheral blood and bone marrow of MM patients was 56. 9% and 84. 4%, respectively. In peripheral blood, the positive rate of IgH gene rearrangement at stage ⅡandⅢ of MM was higher than that at stageⅠ. IgH gene rearrangement of bone marrow could also be detected in cases with complete remission,indicating the presence of minimal residual disease (MRD). Clonal IgH gene rearrangement was not detected in the bone marrow specimens of 11 patients with MGUS and 10 with reactive plasmacytosis. It is concluded that clonal IgH gene rearrangement is of great significance in establishing diagnosis and guiding therapy for MM.