流式细胞技术在诊断B-NHL患者骨髓受累中的应用

Detection of Bone Marrow Involvement by Lymphoma Cells in Patients with B-NHL by Using Flow Cytometry Analysis

本研究探讨流式细胞术(FCM)在诊断B细胞非霍奇金淋巴瘤(B-NHL)患者骨髓受累中的应用意义。利用多参数FCM检测54例初治B-NHL患者的骨髓标本,并结合骨髓形态学和分子生物学检测结果进行分析。FCM诊断B-NHL患者骨髓受累的标准为出现单克隆B细胞。分子生物学方法诊断骨髓受累的标准为出现肿瘤性免疫球蛋白重链(IgH)基因重排。结果表明,在诊断B-NHL患者骨髓受累方面,FCM的检出率最高(27.5%,14/54例),其次为分子生物学方法(22.2%,12/54例),而形态学检出率最低(5.6%,3/54例)。3种方法联合运用,可将B-NHL患者淋巴瘤骨髓受累的检出率提高至38.9%(21/54例)。FCM方法诊断淋巴瘤骨髓受累的14例患者中,骨髓B淋巴细胞kappa/lam bda轻链比值远超过诊断界值。FCM在早期患者(3/26例)中亦能检测到骨髓受累。在3例形态学诊断骨髓受累的患者中,FCM均检测到单克隆B细胞。FCM与分子生物学方法检测结果符合率为70.4%(38/54例,p=0.14)。结论:对于B-NHL患者,运用FCM检测骨髓中单克隆B细胞,在诊断淋巴瘤患者骨髓受累方面敏感性高、准确性好。B-NHL早期患者也存在骨髓受累的可能,应及时在治疗前评价骨髓是否受累。采用FCM、分子生物学检测技术能提高淋巴瘤患者骨髓受累的诊断效率。

This study was purposed to investigate the significance of using（FCM） flow cytometry for detection bone marrow involvement by lymphoma cells in untreated patients with B cell non-Hodgkin′s lymphoma（B-NHL）.Bone marrow samples of 54 patients with B-NHL were analyzed by flow cytometry,morphological method and molecular biology technique.Bone marrow involvement was diagnosed based on the results of morpholpgy,FCM and molecular biology.The results indicated that the positive ratios of bone marrow involvement were different detected by three methods,the most sensitive method was FCM（positive rate was 27.5%）,the moderately sensitive method was molecular biology（positive rate was 22.2%）,the inferior method was morphology method（positive rate was 5.6%）.Combined with three methods,the positive rate increased to 38.9%.The monoclonal B lymphocytes were detected by FCM in fourteen patients,the ratios of kappa light chain /lambda light chain were far beyond the diagnostic threshold.Even in patients with early stage,lymphoma cells still could be detected by FCM in involved bone marrow.Monoclonal B lymphocytes were detected by FCM in three patients who were diagnosed bone marrow involvement by morphological method.The concordance between FCM and molecular biology was relatively high（70.4%,p=0.14）.It is concluded that the detection of monoclonal B lymphocytes by using FCM has high sensitivity and accuracy in patients with B-NHL.Evaluation whether the bone marrow has been involved by lymphoma cells should be recommand to every patient with B-NHL before chemotherapy and every disease stages.Combined application of FCM and molecular biology method would enhance diagnostic efficacy.