流式细胞术测定外周血单克隆B细胞和/或浆细胞在EBV相关移植后淋巴细胞增殖性疾病中的意义  

Peripheral blood monoclonal B-cell and/or plasma cell detection by flow cytometry in screening and monitoring EBV-associated post-transplant lymphoproliferative disorders

作　　者：吴雪英 陈曼 王爱先 甄军毅 宫美维 杜晴 王卉 Wu Xueying;Chen Man;Wang Aixian;Zhen Junyi;Gong Meiwei;Du Qing;Wang Hui(Laboratory Department Hebei Yanda Ludaopei Hospital,Langfang 065201,China)

机构地区：[1]河北燕达陆道培医院检验科,廊坊065201

出　　处：《中华检验医学杂志》2021年第12期1133-1137,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的评估流式细胞术(FCM)外周血筛查单克隆B细胞和/或浆细胞(MC B/P)用于诊断EB病毒(EBV)相关移植后淋巴细胞增殖性疾病(PTLD)的初步应用价值。方法回顾性分析2018年至2019年在陆道培医院进行异基因造血干细胞移植(allo-SCT)后发热、淋巴结大的481例患者的移植后天数、病毒载量(EBV、人类巨细胞病毒)和FCM MC B/P检测等结果, 评估MC B/P诊断PTLD的敏感度、特异度、阳性预测值、阴性预测值等性能。通过logistic回归分析EBV相关PTLD的临床影响因素。中位随访时间为449(184, 700)d。结果经临床确诊为PTLD的患者51例。FCM检测外周血MC B/P阳性的患者55例。外周血MC B/P筛查PTLD的敏感度80.39%, 特异度96.74%, 阳性预测值74.55%, 阴性预测值97.65%。淋巴结肿大, 年龄、EBV、人类巨细胞病毒, 单克隆B细胞以及单克隆浆细胞, 在EBV相关PTLD阴性组与阳性组差异有统计学意义(P<0.05)。通过logistic回归分析, 单克隆B细胞、单克隆浆细胞和移植后发生PTLD的天数与EBV相关PTLD密切相关(P<0.05, AUC=0.853)。结论 FCM进行外周血MC B/P筛查对EBV相关PTLD具有良好的诊断性能。单克隆B细胞、单克隆浆细胞和移植后发生PTLD的天数与EBV相关PTLD具有相关性。Objective To investigate the effectiveness of detecting MC B/P in PB by FCM for EBV+PTLD screening.Methods 481 patients with fever and large lymph nodes after allogenic hematopoietic stem cell transplantation(ALLO-SCT)in Ludaopi Hospital from 2018 to 2019 were retrospectively analyzed.The results of post-transplantation days,viral load(EBV,CMV)and MCB/P were detected.To evaluate the value of MC B/P in the diagnosis of PTLD by the sensitivity,specificity,positive predictive value and negative predictive.Logistic regression was used to analyze the clinical influencing factors of EBV-associated PTLD.The median fellow-up time was 449 days(range:184 days to 700 days).Results The diagnosis of PTLD was established in 51 patients.55 patients who detecting MC B/P by FCM were positive.There were significant differences between the PTLD negative and positive groups in lymph node enlargement,age,EBV,CMV,monoclonal B cells,and monoclonal plasma cells(P<0.05).Monoclonal plasma,monoclonal B and days after transplantation are important relationship with the diagnosis of PTLD,which have good diagnostic value for EBV-associated PTLD.Conclusion FCM screening peripheral blood MC B/P has good diagnostic performance for EBV-associated PTLD.Monoclonal B,monoclonal plasma and the number of days of PTLD after transplantation were correlated with EBV-associated PTLD.

关 键 词：流式细胞术 单克隆细胞 异基因造血干细胞移植 移植后淋巴细胞增殖性疾病 

分 类 号：R457.7[医药卫生—治疗学]