T细胞受体基因VγⅠ—Jγ重排检测在血液病中的临床意义

Clinical significance of T cell receptor VγⅠ-Jγ gene rearrangement expression in common hematopathy

目的本研究采用PCR联合单链构象多态性技术(single strand conformation polymorphism,SS-CP)分析检测TCRVγⅠ—Jγ基因重排在常见血液病的中的表达,结合临床资料初步探讨TCRVγⅠ—Jγ基因重排在常见血液病的中的表达差异和临床意义。方法应用PCR对115例血液病的骨髓进行TCRVγⅠ—Jγ基因重排检测,阳性者行SSCP分析。结果⑴TCRVγⅠ-Jγ基因重排在急性淋巴细胞白血病、淋巴瘤、急性非淋巴细胞性白血病、骨髓增生异常综合征、再生障碍性贫血、特发性血小板减小性紫癜、免疫相关性血细胞减少症和系统性红斑狼疮的阳性率分别为77.78%、71.43%、21.62%、33.33%、77.78%、66.67%、50.00%和100%。⑵急性淋巴细胞白血病部分缓解、完全缓解患者与初治患者积分有显著差异(P值分别为0.013、0.02)。在SSCP中,TCRVγⅠ-Jγ基因重排在不同血液病中表达不同,恶性肿瘤患者表现为单克隆带/有优势寡亚克隆带,非恶性肿瘤患者表现为无优势寡亚克隆带/多克隆带,两者差异显著(P<0.01)。结论(1)TCRVγⅠ-Jγ基因重排检测对淋巴系统恶性肿瘤的诊断有辅助作用。(2)急性非淋巴细胞性白血病、骨髓增生异常综合征也存在TCRVγⅠ-Jγ基因重排。(3)PCR-SSCP检测TCRVγⅠ-Jγ基因重排对良、恶性血液病的鉴别有一定意义。

Objective To investigate the difference and the significance of T cell receptor （TCRVγI-Jγ） gene rearrangement in common hematologic diseases. Methods The clonal rearrangements of TCRγ genes were detected by polymerase chain reaction（PCR） and single strand conformation polymorphism（SSCP） in bone marrow cells from 115 patients with hematologic disease. SSCP was used to detect the cases that were positive samples of TCRVγI-Jγ gene rearrangement in PCR. Results （1）In patients with ALL, ML, AML, MDS, AA, ITP, IRP or SLE, the TCRγ gene rearrangement rates were 77.78%, 72.22%, 37.83%, 46.67%, 77.78%, 66.67%, 50.00% and 100% respectively.（2）The patients of monoclonal or oligoclonal with dominant clone were found by SSCP in the malignant diseases and the cases of polyclone or oligoclonal without dominant clone were found in the benign diseases （P〈 0.05）. Conclusions （1）Detection of the TCRVγI-Jγ gene rearrangement is useful to diagnose lymphocytic malignant disorders. （2）The TCRVγI-Jγ gene rearrangement also can be found in the acute nonlymphocytic leukemia and myelodysplastic syndrome. （3） The TCRVγI-Jγ gene rearrangement is of potential value to differentiate the malignant diseases and the benign diseases by PCR-SSCP.