膜表面免疫球蛋白M检测对慢性淋巴细胞白血病和套细胞淋巴瘤的鉴别价值

The value of surface immunoglobulin M detection in differentiating chronic lymphocytic leukemia and mantle cell lymphoma

目的探讨在慢性淋巴细胞白血病(CLL)和套细胞淋巴瘤(MCL)中诊断和鉴别诊断中,膜表面免疫球蛋白M(sIgM)的应用及意义。方法回顾性收集2016年5月至2022年8月江苏省人民医院血液科收治的首次确诊的CLL患者420例、MCL患者67例的临床资料;CLL患者中,典型免疫表型CLL(tCLL)298例,不典型免疫表型CLL(aCLL)122例。采用多参数流式细胞术(MFC)检测所有患者肿瘤细胞中sIgM和公认的CLL诊断免疫标记物分化抗原簇(CD)200表达水平,并分析sIgM、CD200以及二者联合在aCLL和MCL中的鉴别诊断价值。结果sIgM高表达率在MCL(88.1%)、aCLL(23.0%)、tCLL(8.7%)中依次降低(χ^(2)=193.218,P<0.01);而CD200高表达率反之,在MCL(10.4%)、aCLL(78.7%)、tCLL(92.9%)中依次升高(χ^(2)=261.194,P<0.01)。sIgM对MCL鉴别于aCLL的灵敏度,特异度、阳性预测值、阴性预测值和准确度与CD200相近。sIgM联合CD200相比于单一的CD200或sIgM指标拥有更高的诊断灵敏度(98.5%)和阴性预测值(98.7%)。结论sIgM表达水平在CLL和MCL的诊断,尤其在aCLL和MCL的鉴别诊断中具有很好的临床应用价值。

Objective To investigate the application and significance of membrane surface immunoglobulin M(sIgM) in the differential diagnosis of chronic lymphocytic leukemia(CLL) and mantle cell lymphoma(MCL).Methods The clinical data of 420 first-confirmed CLL patients and 67 MCL patients admitted to the Hematology Department of Jiangsu Provincial People's Hospital from May 2016 to August 2022 were retrospectively collected.Among CLL patients,there were 298 cases of typical immunophenotype CLL(tCLL) and 122 cases of atypical immunophenotype CLL(aCLL).Multiparametric flow cytometry(MFC) was used to detect the expression levels of sIgM and the recognized CLL diagnostic immunomarker CD200 in tumor cells of all patients,and the differential diagnostic value of sIgM,CD200 and their combination in aCLL and MCL was analyzed.Results The high expression rates of sIgM decreased sequentially in MCL(88.1%),aCLL(23.0%),and tCLL(8.7%)(χ^(2)=193.218,P<0.01);On the contrary,the high expression rates of CD200 increased sequentially in MCL(10.4%),aCLL(78.7%),and tCLL(92.9%)(χ^(2)=261.194,P<0.01).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of sIgM in differentiating MCL and aCLL were similar to those of CD200.Compared with the single indicator of CD200 or sIgM,the sIgM combined with CD200 had higher diagnostic sensitivity(98.5%) and negative predictive value(98.7%).Conclusion The sIgM expression level has a good clinical application value in the diagnosis of CLL and MCL,especially in the differential diagnosis of aCLL and MCL.