非霍奇金淋巴瘤患者血浆游离DNA IgH和TCRγ基因重排的检测及临床意义  

The clinical significance of Ig heavy chain and TCRγ gene rearrangement detected in free DNA in plasma in patients with non-Hodgkin lymphoma

作　　者：钟凌[1] 贾永前[1] 孟文彤[1] 唐源[1] 倪勋[1] 

机构地区：[1]四川大学华西医院,成都610041

出　　处：《中华血液学杂志》2008年第4期258-262,共5页Chinese Journal of Hematology

摘　　要：目的检测非霍奇金淋巴瘤（NHL）患者外周血血浆游离DNA免疫球蛋白重链（IgH）基因和T细胞受体γ（TcRγ）基因克隆性重排并探讨其临床意义。方法提取74例NHL患者血浆游离DNA并以Globin基因确定其存在，通过PCR方法检测IgH（FR3A／VLJH）和TcRγ（TVG／TJX）克隆性基因重排，并分别与外周血单个核细胞DNA、病理组织学检查进行比较。结果74例患者中有58例（35例B-NHL和23例T-NHL）初诊、难治或复发的患者血浆游离DNA提取成功，另16例临床缓解患者未提取出血浆游离DNA。35例确诊的B-NHL患者中IgH基因单克隆重排阳性31例（88．6％），无一例出现TcRγ基因单克隆重排，23例确诊的T-NHL患者中TcRγ基因单克隆重排阳性8例（34．8％），其中2例同时出现IgH基因单克隆重排。在50例同时获得病理活检标本基因重排结果的病例中，30例B-NHL患者血浆DNA IgH基因重排阳性26例（86．7％），病理活检标本阳性24例（80．0％）（P〉0．05）；20例T-NHL患者血浆DNA TcRγ基因重排阳性7例（35％），病理活检标本阳性6例（30％）（P〉0．05）。结论NHL患者血浆中可以检测出肿瘤源性的血浆游离DNA；NHL患者血浆游离DNA IgH、TcRγ基因重排的检测简单、方便、相对无创，与病理活检标本的检测具有相同的临床意义。Objective To evaluate the clinical significance of IgH and TCRγ, gene rearrangement in plasma free DNA in patients with non-Hodgkin Lymphoma （NHL）. Methods Plasma free DNA in 74 patients with NHL were extracted and identified by Globin gene. IgH（FR3A/VLJH） , TCRγ（TVG/TJX） clonal rearrangements were amplified by PCR and compared with results of mononuclear cell DNA and pathological biopsy sample DNA. Results Plasma free DNAs were successfully obtained from 58 cases （35 B-NHL and 23 T-NHL） of newly diagnostic, refractory and relapsed NHL out of total 74 patients（78.4% ） , but not found in the rest 16 patients in remission. Of 35 B-NHL cases, 31 showed IgH rearrangement（88.6% ） , and none with TCRγ rearrangement; of 23 T-NHL cases, 8 showed TCRγ rearrangement（34.8% ）,and 2 with IgH gene rearrangement synchronously. In comparation with the results of IgH and TCRγ, gene rearrangement in biopsy samples in 30 B-NHL cases, 26 cases in plasma free DNA （86. 7% ） and 24 in biopsy samples （ 80% ） were positive （P 〉 0.05 ）. In 20 T-NHL patients, 7 cases in plasma cell-free DNA （35%） and 6 cases in biopsy samples （ 30% ） were positive （ P 〉 0.05 ）. Conclusions Tumor-derived DNA could be detected in plasma from underlying cancer patients. For NHL patients, detecting IgH and TCRγ gene rearrangement in plasma free DNA has the same clinical significance as in biopsy samples.

关 键 词：淋巴瘤 非霍奇金 脱氧核糖核酸类 血浆 基因重排 免疫球蛋白类 重链 基因 T细胞受体Γ 

分 类 号：R686[医药卫生—骨科学]