53例非霍奇金淋巴瘤患者临床及实验资料分析

An analysis of the clinical and laboratory data of 53 cases of non-Hodgkin’s lymphoma

目的 分析多种因素对恶性淋巴瘤 (ML)预后的影响 ,并探讨聚合酶链反应 (PCR)检测免疫球蛋白重链 (IgH)和T细胞受体 (TCR)基因重排在协助T、B分型诊断的临床意义。方法 通过SABC法进行免疫分型、PCR方法检测IgH(FR2A ,3A)和TCR( β ,γ)基因重排。 结果 非霍奇金淋巴瘤 (NHL)发病年龄分布呈递增趋势 ,危险比率每年递增 1.0 39n;B NHL发病率为 6 6 .7% ,T NHL为 31.1% ;低度恶性NHL占 5 6 % ,中高度恶性NHL占 44 % ;75 %的患者PCR检测IgH或TCR重排阳性 ,其T、B分型基本与免疫分型相符 ;生存期分析结果 :HD组 3 ,5年生存期分别为 83.3%和 6 2 .5 % ,NHL组 3,5年生存期 :Ⅰ～Ⅱ期患者分别为 88.9%和 6 6 .7% ,Ⅲ～Ⅳ期患者为 39.9%和 33.3% ;低度恶性NHL分别为6 5 .1%和 48.8% ,中高度恶性NHL分别为 47.6 %和 39.6 % ;T与B NHL 2年生存率分别为 5 2 .2 %和70 .2 %。Ⅲ～Ⅳ期NHL移植组生存率略高于常规组。结论 年龄 ,T、B分型 ,恶性度分类和临床分期是影响NHL预后的重要因素 ;APBSCT治疗Ⅲ～Ⅳ期中高度恶性NHL患者可一定程度改善预后 ;分子生物学检测作为辅助手段可以肯定免疫分型结果并补充其不足。

Objective To analyse the influence of factors on the prognoses of non Hodgkin’s lymphoma (NHL) and the clinical usage of IgH and T cell receptor(TCR) gene rearrangement for NHL typing. Methods Immunological phenotyping was carried out by SABC, and IgH(FR2A, FR3A) and TCR(β,γ) detection by PCR. Results The age curve of NHL was increased parallel with the patient's age increasing, hazard ratio was increased 1.039 n annually. The incidence of B cell NHL(B NHL) was 66.7%, T cell NHL(T NHL) was 31.1%, low grade NHL was 56%, middle and high grade NHL were 44%. The positivity of IgH and TCR gene rearrangement in NHL patients were 75% by PCR detection, T and B classification was same as phenotyping. The 3 and 5 years survival ratio: HD were 83.3% and 62.5%, stage Ⅰ～Ⅱ of NHL were 88.9% and 66.7%, stage Ⅲ～Ⅳ of NHL were 39.9% and 33.3%, Low grade NHL were 65.1%and 48.8%, middle and high grade NHL were 47.6% and 39 6%. The survival time of APBSCT group was longer than that of the conventional therapy group.Conclusion Age, T、B classification,grading and staging are the important factors which affect on NHL prognoses. APBCST can improve NHL prognoses, especially for those of stage Ⅲ～Ⅳ patients. Molecular biological methods can help T/B classification when it couldn't be confirmed by phenotyping.