Bcl-2基因在原发胃肠道弥漫大B细胞淋巴瘤中的表达及其对预后的影响

Expression of Bcl-2 gene and its effect on prognosis of patients with primary gastrointestinal diffuse large B-cell lymphoma

目的 探讨Bcl-2 mRNA在原发性胃肠道弥漫大B细胞淋巴瘤（PGI-DLBCL）中的表达情况及其对患者预后的影响.方法 采用实时荧光定量PCR法检测40例PGI-DLBCL组织、17例正常对照组织中Bcl-2 mRNA的表达水平,分析Bcl-2的表达与PGI-DLBCL患者临床病理特征的关系及其对患者预后的影响.结果 PGI-DLBCL组患者Bcl-2 mRNA的表达水平为1.03 ±0.93,高于对照组（0.41±0.21）,差异有统计学意义（P =0.008 9）.ⅡE～Ⅳ期患者Bcl-2 mRNA的表达水平（1.28±1.01）高于Ⅰ～Ⅱ2期患者（0.62 ±0.61,P＜0.05）,国际预后指数（IPI）评分＞2分的患者Bcl-2mRNA表达水平（1.95±1.27）高于IPI评分≤2分者（0.86±0.75,P＜0.05）,化疗后达到完全缓解者Bcl-2 mRNA的表达水平（0.71±0.58）明显低于未达完全缓解者（2.42±0.91,P＜0.05）.单因素分析结果显示,β2微球蛋白水平、Lugano分期、IPI评分和Bcl-2 mRNA表达水平与患者的总生存时间（OS）和无进展生存时间（PFS）均有关（均P＜0.05）.多因素分析结果显示,IPI评分是影响OS的独立因素（P =0.008）,IPI评分和Bcl-2 mRNA表达为影响PFS的独立因素（均P＜0.05）.结论 Bcl-2mRNA在PGI-DLBCL患者肿瘤组织中的表达水平高于正常对照组,其中表达水平较高者对化疗不敏感,预后不佳.IPI评分＞2分和Bcl-2 mRNA高表达是影响PGI-DLBCL患者PFS的独立不良因素.

Objective To explore the expression of Bcl-2 mRNA and its effect on prognosis of patients with primary gastrointestinal diffuse large B-cell lymphoma （PGI-DLBCL）.Methods Real time quantitative PCR was used to determine the expression of Bcl-2 mRNA in 40 PGI-DLBCL patients and 17 healthy controls.The association of Bcl-2 expression with clinicopathological features and prognosis of the patients was analyzed.Results The expression level of Bcl-2 mRNA in PGI-DLBCL patients was 1.03 ± 0.93,significantly higher than that of the controls （0.41 ± 0.21） （P ＜ 0.05）.The expression of Bcl-2 mRNA in stage Ⅱ E-Ⅳ patients （1.28 ± 1.01） was significantly higher than that in the stage Ⅰ-Ⅱ 2 patients （0.62± 0.61） （P ＜ 0.05）.The expression of Bcl-2 mRNA in patients with international prognostic index （IPI） score ＞ 2 （1.95 ± 1.27） was significantly higher than those with IPI score ≤ 2（0.86 ± 0.75） （P ＜ 0.05）.The expression of Bcl-2 mRNA in patients with complete remission （CR） （0.71 ± 0.58） was significantly lower vs.2.42 ±0.91 in patients with no CR （P ＜0.05）.Univariate analysis indicated that β32-MG,IPI score ＞2,the Lugano staging,and Bcl-2 mRNA expression were associated with overall survival （OS） and progression-free survival （PFS） （P ＜ 0.05）.Multivariate analysis indicated that IPI score ＞ 2 was independently associated with OS （P ＜ 0.05）,and both IPI score ＞ 2 and Bcl-2 mRNA expression were independently associated with PFS （P ＜ 0.05）.Conclusions The expression of Bcl-2 mRNA in the tumor tissue of PGI-DLBCL patients is significantly higher than that in controls.PGI-DLBCL patients with higher expression of Bcl-2 have a poor chemotherapy response and inferior prognosis.IPI score ＞ 2 and higher expression of Bcl-2 mRNA are independent poor prognostic factors for PFS in PGI-DLBCL patients.