新型CD45阴性细胞分选技术在多发性骨髓瘤细胞遗传学检测中的临床应用  

Clinical application of a novel CD45-negative cell sorting in cytogenetic detection of multiple myeloma

作　　者：陈果 曾韫璟 王平 邓小娟 项颖 李云龙[3] 彭贤贵 高力 张曦 CHEN Guo;ZENG Yunjing;WANG Ping;DENG Xiaojuan;XIANG Ying;LI Yunlong;PENG Xiangui;GAO Li;ZHANG Xi(State Key Laboratory of Trauma,Burns and Combined Injury,Medical Center of Hematology,PLA Center for Hematology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037;Department of Hematologic Oncology,Chongqing University Cancer Hospital,Chongqing,400030;Department of Hematology,Qijiang People’s Hospital,Chongqing,401420,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院血液病医学中心,全军血液病中心,创伤、烧伤与复合伤国家重点实验室,重庆400037 [2]重庆大学附属肿瘤医院血液肿瘤科,重庆400030 [3]重庆市綦江区人民医院血液内科,重庆401420

出　　处：《第三军医大学学报》2020年第17期1681-1686,共6页Journal of Third Military Medical University

基　　金：重庆市技术创新与应用示范(社会民生类)一般项目资助(CSTC2018jscx-msybX0045);重庆市社会事业与民生保障科技创新专项(CSTC2016shms-ztzx10003)。

摘　　要：目的探讨新型CD45阴性细胞分选技术在多发性骨髓瘤中筛选和富集肿瘤浆细胞的临床价值。方法纳入2018年7月至2019年12月重庆市3家医院60例初诊骨髓瘤患者,每例患者抽取骨髓液3~4 mL,均分为两份,一份直接行流式细胞仪和FISH检测(直接检测组),另一份先行新型CD45阴性细胞分选,之后行流式细胞仪和FISH检测(CD45分选组)。比较每位患者分选前后骨髓液中浆细胞的比例、细胞遗传学异常检出率和危险度分层的情况。结果骨髓液直接检测组浆细胞的比例为(14.5±13.8)%,采用新型CD45阴性细胞分选技术处理后浆细胞比例明显增高为(51.5±30.3)%(P<0.001),分选组浆细胞比例平均为直接检测组(分选前)的7.69倍。骨髓液直接检测组17例患者检出细胞遗传学异常,而新型CD45阴性细胞分选后有39例患者检出细胞遗传学异常,检出率显著增高(P<0.001),IgH重排、13q14缺失、1q21扩增和17p缺失的检测阳性率在分选后均显著增高。根据mSMRAT3.0标准,直接检测组高危患者仅占28.3%,而新型CD45阴性细胞分选后高危患者的比例明显增高(P=0.002),占53.3%。结论新型CD45阴性细胞分选技术简单易行,提高骨髓瘤细胞遗传学异常检出率,准确进行危险度分层以指导治疗,可以推广至基层医院。Objective To explore the clinical value of a novel CD45-negative cell sorting technology in sorting and enriching tumor plasma cells in multiple myeloma(MM).Methods A total of 60 newly diagnosed MM patients from 3 hospitals in Chongqing from July 2018 to December 2019 were recruited in this study.Bone marrow samples of 3~4 mL were taken from each patient and divided into 2 parts.One part(direct detection group)was directly detected by flow cytometry and FISH,and the other part(CD45 sorting group)was subjected to the novel CD45-negative cell sorting,followed by flow cytometry and FISH.The proportion of plasma cells in bone marrow,detection rate of cytogenetic abnormalities and risk stratification were compared in every patient before and after sorting.Results The proportion of plasma cells in bone marrow samples was(14.5±13.8)%and(51.5±30.3)%,respectively,in the direct detection group and CD45 sorting group,with that of the latter group 7.69 times higher than that of the former group(P<0.001).Direct FISH indicated 17 cases of cytogenetic abnormality,while FISH after CD45 sorting found 39 patients having cytogenetic abnormalities(P<0.001).The positive rates of IgH rearrangement,13 q14 deletion,1 q21 amplification and 17 p deletion were all increased significantly after sorting.According to mSMRAT3.0 standard,only 28.3%of the patients were identified at high risk before sorting,but the number was increased significantly after sorting(accounting for 53.3%,P=0.002).Conclusion The new CD45 negative cell sorting technology is simple and easy to operate,and can improve the detection rate of cytogenetic abnormalities and accurately carry out risk stratification for guiding treatment in MM patients.Thus,this technology is worthy of promotion in primary hospitals.

关 键 词：CD45阴性细胞分选 多发性骨髓瘤 细胞遗传学异常 

分 类 号：R329-33[医药卫生—人体解剖和组织胚胎学] R394.2[医药卫生—基础医学]