淋巴结外淋巴组织增生性病变的基因重排研究

Application of Genetic Rearrangement Test on Proliferative Lesion in Lymphadenoid Tissues

目的探讨免疫球蛋白重链(immunoglobulin heavy chain,IgH)基因重排在淋巴结外淋巴瘤及淋巴组织增生性病变中的应用及诊断价值。方法采用PCR半巢氏扩增和免疫组化染色的方法,检测12例难以从形态上区分良恶性的结外淋巴组织增生性(非典型增生组)病变和26例结外B细胞淋巴瘤(淋巴瘤组)的基因重排及表达情况,对所有病例进行不少于5年的随访。结果 26例结外B细胞淋巴瘤21例基因重排阳性(80.8%)。各组间重排阳性例数经统计学分析及PCR半定量检测,各组间差异存在统计学意义。所有病例均经免疫组织化学染色,全部为非霍奇金B细胞淋巴瘤。经统计学计算分析,PCR重排的特异性为87.5%,敏感性为90%,准确率为89.5%;免疫组化特异性100%,敏感性76.7%,准确率81.6%。随访结果证实,基因重排阳性病例均为淋巴瘤。结论基因重排结果的敏感性、准确率均优于免疫组化染色结果。基因重排检测对结外疑难淋巴组织增生性病变和淋巴瘤鉴别诊断提供了一种可行的辅助手段。

Objective To explore the application and diagnostic value of genetic rearrangement testing on im-munoglobulin heavy chain （IgH） gene in the lymphadenoid lymphoma and lymphadenoid proliferative lesions. Methods 12 cases with the lymphadenoid hyperplastic lesions that couldn＇t be easily distinguished only by morphology and 26 cases with B cell lymphoma were employed for experimental group, 10 normal cases for control group. Standard kit extract DNA, The polymerase chain reaction （PCR） and Agarose gel electrophore-sis were conducted to obsvere the incidence of genetic rrangemen in IgH. Immunohistochemistry was used for marking all cases. Results 21 cases in the group of lymphadenoid hyperplastic lesions and B cell lymphoma respectively showed an positive reaction（80.8% ）. All cases were non-Hodgkin B cell lymphomo confirmed by immunohistochemical staining. The pecificity of the PCR rearrangement was 87.5%, sensitivity was 90%, the accuracy rate was 89.5% . Immunohistochemical specificity was 100%, sensitivity was 76.7% and accu-racy was 81.6%. The follow - up results confirmed that the gene rearrangement of positive cases were patients with lymphoma. Conclusion The calculation results of gene rearrangement of the sensitivity, accuracy is bet-ter than immunohistochemical study results. Gene rearrangement test is a liable technique for the differential diagnosis between lymphadenoid tissue hyperplastic lesions and lymphoma, by which the difficult cases will be resolved effectively.