CAJ | 학술논문

目的探讨半巢式聚合酶链反应(PCR)检测B细胞淋巴瘤患者骨髓中IgH基因克隆性重排的可行性,并初步评价其临床价值.方法选用FR2、FR3A引物,采用半巢式PCR方法检测105例B细胞淋巴瘤患者骨髓中IgH基因的单克隆性重排,与骨髓穿刺细胞形态学检测结果进行比较,并评价PCR检测结果与临床病理特征的关系.结果 105例B细胞淋巴瘤患者中,IgH基因克隆性重排PCR检测48例(45.7%)阳性,而骨髓细胞形态学只检测出22例(21.0%),两者差异有统计学意义(P<0.05),符合率为71.4%(75/105).弥漫大B细胞性淋巴瘤(DLBCL)、滤泡性淋巴瘤(FL)及小淋巴细胞性淋巴瘤(SLL)初治患者PCR检测阳性率分别为30.8%、25.0%和100.0%.PCR检测结果与Ann Arbor分期有关,早期B细胞淋巴瘤患者lgH基因克隆性重排PCR检出阳性率低于晚期患者(P=0.02).PCR检测阳性和阴性患者的近期疗效差异无统计学意义(P>0.05),但CR率(23.3%和46.3%)差异有统计学意义(P=0.019).结论 IgH基因克隆性重排PCR检测可能是判断B细胞淋巴瘤患者骨髓异常的有效方法,较骨髓细胞形态学敏感;Ann Arbor分期晚的患者PCR检测阳性率高于分期早的患者;PCR检测阳性者治疗后获得CR的机会低于阴性者.
목적 탐토반소식취합매련반응(PCR)검측B세포림파류환자골수중IgH기인극륭성중배적가행성,병초보평개기림상개치.방법 선용FR2、FR3A인물,채용반소식PCR방법검측105례B세포림파류환자골수중IgH기인적단극륭성중배,여골수천자세포형태학검측결과진행비교,병평개PCR검측결과여림상병리특정적관계.결과 105례B세포림파류환자중,IgH기인극륭성중배PCR검측48례(45.7%)양성,이골수세포형태학지검측출22례(21.0%),량자차이유통계학의의(P<0.05),부합솔위71.4%(75/105).미만대B세포성림파류(DLBCL)、려포성림파류(FL)급소림파세포성림파류(SLL)초치환자PCR검측양성솔분별위30.8%、25.0%화100.0%.PCR검측결과여Ann Arbor분기유관,조기B세포림파류환자lgH기인극륭성중배PCR검출양성솔저우만기환자(P=0.02).PCR검측양성화음성환자적근기료효차이무통계학의의(P>0.05),단CR솔(23.3%화46.3%)차이유통계학의의(P=0.019).결론 IgH기인극륭성중배PCR검측가능시판단B세포림파류환자골수이상적유효방법,교골수세포형태학민감;Ann Arbor분기만적환자PCR검측양성솔고우분기조적환자;PCR검측양성자치료후획득CR적궤회저우음성자.
Objective To explore the feasibility of semi-nested PCR technique for detection of immunoglobulin heavy chain (IgH) clonal rearrangement in bone marrow of B-cell lymphoma patient and to further evaluate its clinicopathulogical value. Methods Gene clonal rearrangement of IgH was detected by semi-nested PCR using primers of FR2 & FR3A in 105 bone marrow samples of patients with B-cell lymphoma. The PCR detection results were compared with the cytomorphology of bone marrow aspiration biopsy. The correlation between PCR detection results and clinicopathological factors were evaluated. Results Among 105 cases of B-cell lymphoma, bone marrow involvement was detected by PCR technique in 48 cases (45.7%), while only 22 cases (21.0%) were detected by bone marrow cytological analysis. There was a significant difference between two methods (P<0.05), and the concordance rate was 71.4%. The incidence of bone marrow involvement at the time of initial diagnosis detected by PCR technique was 30. 8% for diffuse large B cell lymphoma (DLBCL), 25.0% for follicular lymphoma (FL), and 100.0% for small lymphocytic lymphoma (SLL), respectively. Bone marrow involvement detected by PCR detection correlated with Ann Arbor stage. Rate of clonal IgH gene rearrangement by PCR in early B-cell lymphoma was lower than that in advanced stage B-cell lymphoma patients (P=0.02). There was no statistically significant difference in efficacy between patients with positive and negative results detected by PCR (P>0.05). But difference in complete response (CR) rate (23.3% and 46.3%) had significant difference (P=0.019). Conclusion Semi-nested PCR analysis may be an effective method for detection of abnormalities in bone marrow in patients with B-cell lymphoma and is superior to cytomorphology. The positive rate in patients with advanced Ann Arbor stage is higher than that in patients with early Ann Arbor stage, and patients with PCR negative result have more chances to achieved CR after treatment.