血液系统肿瘤患者外周血细胞IgH基因和TCRγ基因的检测及意义

The Significance of Detecting the Clonal Rearrangements of Immunoglobulin Heavy Chain Gene and T cell Receptor γ Gene in Peripheral Blood Cells of Patients with Hemapoietic Malignancies

检测各种血液系统肿瘤患者外周血细胞免疫球蛋白重链基因 (IgH )和T细胞受体γ基因 (TCRγ )克隆性重排并探讨其意义。通过多聚酶链式反应 (PCR )方法检测 32例非霍奇金淋巴瘤 (NHL )、 18例急性髓性白血病 (AML )、 2 4例多发性骨髓瘤 (MM )、 8例急性淋巴细胞白血病 (ALL )及 6例慢性淋巴细胞白血病 (CLL )患者外周血细胞IgH及TCRγ克隆性基因重排。结果表明 ,NHL、AML、MM、ALL及CLL患者中IgH克隆性重排率分别为 37 5 0 %、 2 2 2 2 %、 83 33%、 12 5 0 %和 16 6 7% ;TCRγ基因克隆性重排率分别为 6 2 5 0 %、 5 0 0 0 %、 5 4 17%、 5 0 0 0 %及 5 0 0 0 %。在B型、T型NHL中 ,IgH克隆性重排率分别为 31 5 8%及 6 6 6 7% ;TCRγ克隆性重排率分别为 47 37%及 6 6 6 7%。AML中IgH克隆性重排阳性者的初治完全缓解率(CR ) (5 0 0 0 % )与IgH重排阴性的初治CR率 (5 0 0 0 % )无显著差异 (P >0 0 5 )。TCRγ克隆性重排阳性者与阴性者的初治CR率 (均为 44 44 % )亦无显著差异 (P >0 0 5 )。IgH及TCRγ基因克隆性重排不具有细胞谱系的特异性 ,但通过检测外周血IgH、TCRγ克隆性基因重排对NHL有辅助诊断意义 ,并且可作为监测微小残留病壮 (MRD )的手段。

To investigate the clonal rearrangements of immunoglobulin heavy chain gene (IgH) and T cell receptor γ gene (TCRγ) in peripheral blood cells of patients with hemapoietic malignancies and their significance,the clonal rearrangements of IgH and TCRγ genes were detected by polymerase chain reaction (PCR) in peripheral blood cells of patients with hemapoietic malignancies,including 32 cases of non Hodgkin lymphoma (NHL),18 cases of acute myeloid leukemia (AML),24 cases of multiple myeloma (MM),8 cases of acute lymphoblastic leukemia (ALL) and 6 cases of chronic lymphoblastic leukemia (CLL) In patients with NHL,AML,MM,ALL and CLL,the IgH gene clonal rearrangement rates were 37 50%,22 22%,83 33%,12 50% and 16 67% respectively,and the TCRγ gene clonal rearrangement rates were 62 50%,50 00%,54 17%,50 00% and 50 00% respectively In patients with T cell and B cell NHL,IgH gene clonal rearrangement rates were 31 58% and 66 67%,and TCRγ gene clonal rearrangement rates were 47 37% and 66 67% There was no obvious difference between those with IgH clonal rearrangement and those without IgH clonal rearrangement (P>0 05) and between those with TCRγ clonal rearrangement and those without TCRγ clonal rearrangement (P>0 05) in the complete remission rates after the first chemotherapy From these it con cludes the clonal rearrangements of IgH and TCRγ genes may have on lineage specificity,but detection of IgH and TCRγ gene clonal rearrangements in peripheral blood cells may be helpful in diagnosis of NHL and is an efficient method in surveillance of minimal residual disease (MRD) Key words hemapoietic malignancies;gene rearrangement;IgH;TCRγ CDE will take important role in detecting the cancer in early stage or studying its hemodynamics in future.