血循环DNA在淋巴瘤中的定量检测及其临床意义  

Quantitation of Circulating Cell-free DNA in Patients with Lymphoma and Its Clinical Significance

作　　者：陈园园[1] 郭素青[1] 李英华[1] 王东梅[1] 刘晓[1] 张永晓[1] 王树叶[2] 

机构地区：[1]哈励逊国际和平医院血液内科,河北衡水053000 [2]哈尔滨医科大学附属第一医院血液内科,黑龙江哈尔滨150001

出　　处：《中国实验血液学杂志》2016年第5期1390-1396,共7页Journal of Experimental Hematology

基　　金：国家重点基础研究发展计划子课题(2012CBA01303)

摘　　要：目的:了解血循环DNA含量在淋巴瘤筛查中的应用价值,分析其与标准化疗方案治疗后治疗效果及预后的关系,探讨血循环DNA定量在淋巴瘤评估疗效及指导预后中的重要作用。方法:收集32例浅表淋巴结肿大的淋巴瘤者21例(标准化疗方案前后分别采集外周血标本)和淋巴结炎者11例的外周血标本。另选取9名健康志愿者的外周血标本作为健康对照组。使用荧光定量PCR方法检测各组标本的血循环DNA水平,分析血循环DNA在不同组别中的表达水平,了解其与淋巴瘤临床特征间的联系,评估血循环DNA清除率在治疗效果及预后判断中的重要作用。结果:淋巴瘤患者的血循环DNA水平均明显高于淋巴结炎者和健康志愿者(56.71±50.61)ng/ml vs(19.21±15.52)ng/ml和(8.26±7.06)ng/ml,(P=0.033和P=0.010),后两者间无统计学意义(P=0.118)。淋巴瘤患者血循环DNA与乳酸脱氢酶水平明显相关(P=0.032)。当血循环DNA水平24.67 ng/ml作为诊断淋巴瘤的临界值时,其敏感度为75%,特异度为85%。标准方案化疗结束后血循环DNA清除率高的患者,完全缓解率高(P=0.032),总生存期长(P<0.001)。结论:血循环DNA在淋巴瘤中明显增高,可能有助于淋巴瘤筛查。血循环DNA水平有可能作为淋巴瘤疗效判断及预后评估的一个潜在指标。Objective：To evaluate the value of circulating cell-free DNA（CFDNA） quantification for screening lymphoma,to analyse the relationship of circulating CFDNA with curative effect under standard therapeutic schedule,and to determine whether circulating CFDNA could be applied to monitor and prognosticate lymphoma.Methods：The peripheral blood samples from 32 patients（21 cases of lymphoma and 11 cases of lymphadenitis） with superficial lymph node enlargement were collected,9 healthy volunteers were as the normal control.Fluorescent quantitative PCR was used to detect the circulating CFDNA in 3 groups.Then,the relationship of circulating CFDNA with common characteristics of lymphoma was analysed,so as to evaluate the importance of circulating CFDNA to the curative effect and prognosis.Results：The circulating CFDNA level in patients with lymphoma was higher than that in patients with lymphadenitis and healthy volunteers（56.71 ±50.61） ng/ml vs（19.21±15.52） ng/ml and（8.26 ±7.06） ng/ml（P〈0.05）,but the difference between the latter 2 was not statistically significant（P= 0.118）.The circulating CFDNA level in lymphoma significantly correlated with the level of lactate dehydrogenase（LDH）（P〈0.05）.ROC analyses revealed that the detection of plasma DNA could discriminate the lymphoma from normal controls with 75%sensitivity,85%specificity and with a cut-off value of 24.67 ng/ml.The higher circulating CFDNA clearance rate after standard therapy,the higher the rate of complete remission（CR）（P〈0.05） and the longer overall survival（P〈0.001）.Conclusion：Elevated circulating cell-free DNA levels may be useful as a screening tool for lymphoma.Circulating CFDNA level may serve as a potential indicator for evaluation of the curative effect and prognosis.

关 键 词：淋巴瘤 血循环DNA 定量检测 淋巴瘤预后 

分 类 号：R733.1[医药卫生—肿瘤]