骨髓穿刺物的检测对非霍奇金淋巴瘤患者骨髓受累的诊断和患者预后评估的价值  

Diagnosis and Prognosis Value of Bone Marrow Aspirate Detection for the Bone Marrow Involvement in Non-Hodgkin’s Lymphoma Patients

作　　者：高帆 克晓燕[1] 王晶[1] 朱明霞[1] 胡凯[1] GAO Fan;KE Xiao-Yan;WANG Jing;ZHU Ming-Xia;HU Kai(Department of Hematology,Peking University Third Hospital,Beijing 100088,China)

机构地区：[1]北京大学第三医院血液科,北京100088

出　　处：《中国实验血液学杂志》2020年第2期488-494,共7页Journal of Experimental Hematology

摘　　要：目的:比较并评估非霍奇金淋巴瘤骨髓侵犯的各种检测方法的敏感度、特异度和提示预后的价值。方法:2013年1月至2017年11月在北京大学第三医院就诊并行骨髓穿刺的检查的NHL患者共351例。对这些患者分别统计骨髓活检(bone marrow biopsy,BMB)、流式细胞术(flow cytometry,FCM)、基因重排(gene rearrangement,GR)、骨髓形态学检查的骨髓受累检出率。以骨髓活检为金标准,观察FCM、基因重排、骨髓形态学的敏感度、特异度,并绘制ROC曲线。在77例NHL患者的生存分析中,分别统计患者的总生存期(OS)、无进展生存期(PFS)、完全缓解率(CRR)。对比FCM阳性组、基因重排阳性组与阳性对照组(BMB阳性组)、阴性对照组患者的生存情况。结果:骨髓穿刺物的流式细胞术和基因重排检测骨髓受累较骨髓活检、骨髓形态学检测有更高的检出率,且两者都具备比较良好的诊断效能。流式细胞术和基因重排联合检测骨髓受累的敏感度为82.5%,而特异度达90%,AUC为0.863,诊断效能良好。骨髓穿刺物的基因重排检测对NHL患者具有提示不良预后的作用,基因重排阳性组(RG group)患者的3年生存率较无骨髓受累的组(All negative group)低(P<0.05);RG组患者的生存曲线虽然较All negative组无显著差别(P<0.1),但仍提示患者有较差的预后,且在Cox回归模型中体现出可预测死亡风险(P<0.05)。而FCM阳性组(FCM group)预后没有统计学差异。结论:骨髓穿刺物检验中,流式细胞术和基因重排方法具有较好的诊断效能,基因重排检测可提示患者的预后。而两种方法联合检测效能更好。Objective:To compare and evaluate the sensitivity,specificity,and prognostic value of various assays for bone marrow involvement in patients with non-Hodgkin’s lymphoma(NHL).Methods:A total of 351 patients with NHL who underwent concurrent bone marrow biopsy in Third Hospital of Peking University from January 2013 to November 2017 were selected.Bone marrow biopsy(BMB),flow cytometry(FCM),gene rearrangement detection,and bone marrow morphology examination were performed for evaluation of bone marrow involvement.Bone marrow biopsy was used as the gold standard,the sensitivity and specificity of FCM,gene rearrangement and bone marrow morphology of bone marrow aspirate were analyzed,and their ROC curves were drawn.In the survival analysis of 77 patients with NHL,the overall survival(OS)time,progression-free survival(PFS)time,and complete remission rate(CRR)were counted.The survival of patients in the FCM positive group,the gene rearrangement positive group,the positive control group(BMB positive group)and the negative control group were compared.Results:The detection rate of flow cytometry and gene rearrangement of bone marrow aspirate both were higher than that of bone marrow biopsy and bone marrow morphological examination,showing better diagnostic efficacy.The sensitivity of the combined method of flow cytometry and gene rearrangement was 82.5%,while the specificity was 90%and the AUC was 0.863.The gene rearrangement detection of bone marrow aspirate possessed the role suggesting the poor prognosis for NHL patients.The 3-year survival rate of patients in the gene rearrangement-positive group(RG group)was lower than that of patients in the no-bone involvement group(All negative group)(P<0.05).Although the survival curve of patient in RG group was not significantly different from that of patients in All negative group(P<0.1),it still showed a poor prognosis for NHL patients.And the significance of predicting death risk was reflected in Cox regression model(P<0.05).There was no statistical difference in the prognos

关 键 词：非霍奇金淋巴瘤 骨髓受累 流式细胞术 基因重排 

分 类 号：R733.1[医药卫生—肿瘤]