CAJ | 학술논문

目的探讨我国CD5+B淋巴增殖性疾病(B-LPD)免疫表型特点.方法采用流式细胞术分析B-LPD患者骨髓和(或)外周血细胞免疫表型特点,比较各免疫标志表达差异,并结合临床特点进行回顾性分析.应用荧光原位杂交(FISH)检测t(11;14)以诊断或排除套细胞淋巴瘤.结果 ①共260例患者纳入研究,其中慢性淋巴细胞白血病(CLL) 186例(71.5％),套细胞淋巴瘤(MCL)38例(14.6％),其他B-LPD包括脾边缘区淋巴瘤(5例)、毛细胞白血病(3例)、B幼淋巴细胞白血病(2例)共10例(3.8％);另外26例(10.0％)患者尚无法确诊亚类,暂定为不能分类的B-LPD(BLPD-U).MCL患者均经FISH检测t(11;14)阳性而诊断,BLPD-U均为t(11;14)阴性.②所有患者均表达CD19、CD20和CD5.依据CLL免疫表型积分系统,186例CLL患者积分均为4～5分,CLL患者CD23、sIgM、FMC7、CD22和CD11c阳性率分别为99.5％、11.3％、10.2％、44.1％和51.1％;MCL患者免疫表型积分均为1～3分,上述抗原阳性率分别为50.0％、50.0％、81.6％、92.1％和5.3％;BLPD-U患者上述抗原阳性率分别为73.1％、34.6％、88.5％、92.3％和69.2％;其他B-LPD患者上述抗原阳性率分别为50％、60％、100％、90％和70％.③CLL与MCL比较,CD23、sIgM、FMC7、CD22和CD11c表达在两者间差异均有统计学意义(P值均＜ 0.01);MCL与BLPD-U比较,仅CD11c表达在两者间差异有统计学意义(P＜0.01);MCL与其他B-LPD比较,CD11c的表达在两者间差异有统计学意义(P＜0.01).西方人群中,MCL中CD23表达率为7％～21％,sIgM的表达率为82％～ 100％,其免疫标志与本研究类似.结论我国MCL患者CD23阳性率显著高于西方人群,而sIgM表达率显著低于西方人群.CD11c可作为MCL与CLL及其他CD5+ B-LPD鉴别的有用标志.
목적 탐토아국CD5+B림파증식성질병(B-LPD)면역표형특점.방법 채용류식세포술분석B-LPD환자골수화(혹)외주혈세포면역표형특점,비교각면역표지표체차이,병결합림상특점진행회고성분석.응용형광원위잡교(FISH)검측t(11;14)이진단혹배제투세포림파류.결과 ①공260례환자납입연구,기중만성림파세포백혈병(CLL) 186례(71.5％),투세포림파류(MCL)38례(14.6％),기타B-LPD포괄비변연구림파류(5례)、모세포백혈병(3례)、B유림파세포백혈병(2례)공10례(3.8％);령외26례(10.0％)환자상무법학진아류,잠정위불능분류적B-LPD(BLPD-U).MCL환자균경FISH검측t(11;14)양성이진단,BLPD-U균위t(11;14)음성.②소유환자균표체CD19、CD20화CD5.의거CLL면역표형적분계통,186례CLL환자적분균위4～5분,CLL환자CD23、sIgM、FMC7、CD22화CD11c양성솔분별위99.5％、11.3％、10.2％、44.1％화51.1％;MCL환자면역표형적분균위1～3분,상술항원양성솔분별위50.0％、50.0％、81.6％、92.1％화5.3％;BLPD-U환자상술항원양성솔분별위73.1％、34.6％、88.5％、92.3％화69.2％;기타B-LPD환자상술항원양성솔분별위50％、60％、100％、90％화70％.③CLL여MCL비교,CD23、sIgM、FMC7、CD22화CD11c표체재량자간차이균유통계학의의(P치균＜ 0.01);MCL여BLPD-U비교,부CD11c표체재량자간차이유통계학의의(P＜0.01);MCL여기타B-LPD비교,CD11c적표체재량자간차이유통계학의의(P＜0.01).서방인군중,MCL중CD23표체솔위7％～21％,sIgM적표체솔위82％～ 100％,기면역표지여본연구유사.결론 아국MCL환자CD23양성솔현저고우서방인군,이sIgM표체솔현저저우서방인군.CD11c가작위MCL여CLL급기타CD5+ B-LPD감별적유용표지.
Objective To explore the immunophenotypic characteristics of CD5+ B cell lymphoproliferative disorders (B-LPD) of Chinese patients.Methods Immunophenotyping of bone marrow and (or) of peripheral blood was performed in patients with B-LPD by four color multiparameter flow cytometry analysis using a panel of monoclonal antibodies,and the patients clinical data were retrospectively analyzed.The difference in immunophenotypes and the related clinical features were retrospectively analyzed.Fluorescence in situ hybridization (FISH) for t (11; 14) detection was applied to diagnose or exclude mantle cell lymphoma.Results ①A total 260 CD5+B-LPD patients were enrolled in this study,including 186 chronic lymphocytic leukemia (CLL),40 mantle cell lymphoma (MCL),other B-LPD including 5 splenic marginal zone lymphoma (SMZL),2 B-cell prolymphocytic leukemia (B-PLL),3 hairy cell leukemia (HCL).The other 26 cases (10％) were not classified and defined as unclassifed B-LPD (BLPD-U).MCL patients were all positive for t (11;14) detected by FISH,while all the BLPD-U patients were negative for t (11;14).②All patients expressed CD19,CD20 and CD5.According to the immunophenotypic score system,186 CLL patients scored 4-5,99.5％ of patients with CD23+,11.3％ with sIgM+,10.2％ with FMC7+,44.1％ with CD22+ and 51.1％ with CD11c+.MCL patients scored 2-3,with 50％ expressing CD23 and sIgM,81.6％ expressing FMC7,92.1％ expressing CD22 and 5.3％ expressing CD1 1c.In aspect of BLPD-U and other B-LPD,the expression of CD23,sIgM,FMC7,CD22 and CD11c were 73.1％ and 50％,34.6％ and 50％,88.5％ and 100％,92.3％ and 90％,69.2％ and 70％,respectively.③In comparison of CLL with MCL,there was a significant difference in the expression of CD23,sIgM,FMC7,CD22 and CD11c between the two groups (P＜0.01).Between MCL and BLPD-U,similar expression type of CD23,sIgM,FMC7 and CD22 was found except CD1 1c,which was highly expressed in BLPD-U (P＜0.001).The difference of CD11c expression was also statistically significant between MCL and other B-LPD (P ＜ 0.01).In comparison of MCL with other B-LPD,there was a significant difference in the expression of CD1 1c (P ＜ 0.01).The expression of CD23 and sIgM in MCL are 7％-21％ and 82％-100％ respectively in Western population,while the expression of other immunophenotypic markers is similar with our study.Conclusion The significant high incidence of CD23 and low incidence of sIgM compared to the Western population was observed in Chinese patients,and CD11c coud serve as a useful marker to distinguish MCL from CLL and other CD5+ B-LPD.