血清单克隆免疫球蛋白在慢性B淋巴细胞增殖性疾病中的表达及其意义

Expression of serum monoclonal immunoglobulins in B-cell chronic lymphoproliferative disorders and their significances

目的研究血清单克隆免疫球蛋白（McIg）在慢性B淋巴细胞增殖性疾病（B-CLPD）中的表达情况，分析其临床意义及可能来源。 方法回顾性分析2006年5月至2015年5月1 147例初诊B-CLPD患者临床资料，分析血清McIg表达情况及预后相关因素，探讨其来源。 结果1 147例B-CLPD患者中淋巴浆细胞淋巴瘤/华氏巨球蛋白血症（LPL/WM）患者164例，其中140例（85.4%）存在McIg；非LPL/WM患者983例，其中50例（5.1%）存在McIg；两组McIg类型均以IgM型为主。McIg阳性LPL/WM组、McIg阳性的非LPL/WM组及McIg阴性组患者血清IgM浓度分别为（48.88±33.42）g/L、（27.9±15.23）g/L、（2.75±1.21）g/L，差异有统计学意义（P=0.000），McIg阳性的LPL/WM组IgM浓度高于McIg阳性非LPL/WM组（P=0.000），且两组患者血清IgM浓度均高于McIg阴性者（P值均为0.000）。分析16例McIg阳性非LPL/WM的B-CLPD患者显示，治疗后完全缓解期间单克隆IgG、IgM的水平变化均低于初诊时（P值分别为0.001、0.048）。非LPL/WM的B-CLPD患者中β2微球蛋白高水平组及染色体复杂核型组血清McIg阳性率分别高于β2微球蛋白低水平组（P=0.001）及染色体正常核型组（P=0.016）。47例McIg阳性的非LPL/WM患者中，38例（80.9%）血清McIg表达类型与肿瘤细胞表面Ig轻链的类型一致，二者中度相关（P〈0.005）。 结论部分非LPL/WM的B-CLPD患者血清中也存在McIg，且可能和预后有一定相关性。McIg可能是由肿瘤细胞或与肿瘤细胞有共同前体的细胞分泌的。

ObjectiveTo investigate the incidence of serum monoclonal immunoglobulins （McIg） in B-cell chronic lymphoproliferative disorders （B-CLPD） and the clinical significance of McIg in B-CLPD and its possible sources. MethodsA total of 1 147 patients with B-CLPD treated from May 2006 to May 2015 were enrolled into this retrospective study. The incidence of McIg and the relationship between McIg and prognostic factors in patients with B-CLPD were analyzed. ResultsOut of 1 147 B-CLPD patients, there were 164 patients with lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia （LPL/WM）, and among them, McIg was detected in 140 cases （85.4%）. In the remaining 983 patients with B-CLPD, monoclonal Ig was detected in 50 （5.1%） patients. Most of McIg in 2 groups were IgM paraprotein. The levels of IgM paraprotein of the LPL/WM group, non-LPL/WM group and McIg-negative patients were （48.88 ± 33.42） g/L, （27.9 ± 15.23） g/L and （2.75±1.21） g/L, respectively, the difference was statistical significance （P=0.000）; the level of IgM paraprotein in LPL/WM group was significantly higher than that in non-LPL/WM group （P=0.000）. The level of paraprotein decreased significantly when the patients got complete response after therapy （P=0.001, 0.048, respectively）. The incidence of serum McIg was higher in the group with complex karyotype （P=0.016） and with high level of β2-microglobulin （β2-MG） （P=0.001）. In the 47 non-LPL/WM patients with positive McIg, serum McIg in 38 （80.9%） patients were expressed in a pattern consistent with the distribution of tumor cells （P〈0.005）. Most of the light chain subtype of the McIg were consistent with the light chain subtype of the membrane immunoglobulin on the tumor cells. ConclusionsSome non-LPL/WM B-CLPD patients also have serum McIg, and it could have certain relevance with the prognosis of B-CLPD. Moreover, the McIg may be secreted by tumor cells or those derived from the same progenitor cells with tumor cells.