血管免疫母细胞性淋巴结病病变性质的研究  

NATURE OF ANGIO-IMMUNOBLASTIC LYMPHADENOPATHY

作　　者：纪祥瑞[1] 姜天福[2] 李玉军[2] 赵鹏[2] 张华[2] 刘海静[1] 孙显路[2] 

机构地区：[1]青岛大学医学院病理学教研室,山东青岛266003 [2]青岛大学医学院附属医院病理科,山东青岛266003

出　　处：《青岛大学医学院学报》2004年第1期1-7,共7页Acta Academiae Medicinae Qingdao Universitatis

基　　金：山东省科技厅科研基金资助项目 ( 12 165 0 8)

摘　　要：①目的　通过对血管免疫母细胞性淋巴结病 (AIL)较系统的研究 ,进一步认识AIL的病变性质 ,探讨其可能的发病机制和病因 ,筛选对判定AIL病变性质有临床实用价值的方法和指标。②方法　在临床病理研究的基础上 ,采用PCR技术、免疫组化技术、图像分析技术 ,对 4 4例符合AIL组织学诊断标准病例的免疫表型、基因重排、bcl 2 /IgH融合基因、EBV DNA、DNA含量、P5 3蛋白、bcl 2、c myc、EB病毒潜伏膜蛋白 (LMP 1 )、PCNA等多项指标进行检测分析 ;同时选择非何杰金淋巴瘤 (NHL) 2 0例和淋巴结反应性增生 1 0例作为对照。③结果4 4例AIL的临床表现十分复杂 ,呈多系统、多脏器受累的复杂的临床表现 ;有在某季节 (春季 )集中发病的倾向。AIL的免疫表型表现为以T细胞增生为主。在组织学上 ,AIL表现为良恶性增生兼有的特征 ,片巢状透明细胞增生的出现是诊断恶性的组织学特征。 4 4例AIL中有 1 6例 (36 .7% )为克隆性基因重排阳性 ,其中 1 2例为TCRγ克隆性重排 ,2例为IgH克隆性重排 ,2例为TCRγ和IgH双重排 ,其克隆性重排的检出率在AIL、NHL和反应性增生间的差异均有显著意义 (χ2 =8.2 1 8～ 2 6 .0 36 ,P <0 .0 1 )。 4 4例AILP5 3蛋白阳性表达率为 31 .8% ,2 0例NHLP5 3蛋白阳性表达率为 70 .0 % ,反应性增生者无?Objective To probe into the nature and pathogenesis and etilology of angioimmunoblastic lymphadenopathy(AIL), and to screen the clinical methods and indicators for determining the nature of AIL.\ Methods\ The forty four cases consistent with the histological criteria for AIL were collected. On the basis of the clinicopathological research, DNA extracted from Parafin Embedded tissue of AIL was analyzed with polymerase chain reaction(PCR) for the gene rearrangement of IgH and TCRγ,bcl 2/IgH fusion gene, and EBV DNA was detected. Immunogenotype analysis and expressions of P53 protein,bcl 2,c myc,LMP 1,PCNA were detected by immunohistochemistry. DNA content was made by image analysis technique. Twenty cases of Non Hodgkin lymphoma(NHL) and 10 case of reactive lymphoproliferation(RLP) were used as controls. \ Results\ Two clinical features were found in the 44 cases of AIL: The clinical manifestation of AIL was very complicated, which involved multi systemic organs; AIL tended to attack in the spring. The immunogenoytpe of AIL was mostly T cell hyperplasia. Histologically, AIL exhibited features of both benign and malignant hyperplasia; appearance of clear cell nests indicates a malignant feature. Sixteen(36.7%) out of 44 cases of AIL showed clonally rearranged IgH or/and TCRγ gene, in which 12 showed TCRγ, 2 showed IgH gene rearrengement, and another 2 were detected as double rearrangement of IgH and TCRγ genes. The positive rates of clonal gene rearrangement showed significant difference between AIL and NHL,AIL and RLP ( χ 2=8.218-26.036, P <0.01). P53 expression rate was 31.8% and 70.0% in 44 AIL and 20 NHL cases, respectively. No P53 expression was detected in patients with recective hyperplasia. The difference among the three groups was significant ( χ 2=8.145,28.033, P <0.05). Significant differences were also found between AIL and NHL, and AIL and RLP ( P <0.05). DNA content analysis, expression of bcl 2, PCNA index in the AIL cases were significantly different from those in NHL and RL

关 键 词：血管免疫母细胞性淋巴结病 病变性质 基因重排 DNA 蛋白质P53 原癌基因蛋白质 C-MYC 

分 类 号：R551.2[医药卫生—血液循环系统疾病]