非霍奇金淋巴瘤IgH基因重排分析及其意义

目的 探讨免疫球蛋白重链(IgH)基因重排的检测在非霍奇金淋巴瘤(NHL)中的诊断价值.方法 用半巢式和混合聚合酶链式反应(PCR)方法,联合使用IgH FR3A、FR2A、FR1家族特异性引物Mixtures(VH1、VH2、VH3)检测44例B-NHL患者、1例未分型淋巴瘤、15例T-NHL患者和5例淋巴结反应性增生患者IgH基因克隆性重排情况.结果 ①采用FR3A引物,44例B-NHL有37例出现克隆性IgH基因重排,检测率为84%(37/44);采用FR2A引物,有27例出现克隆性IgH基因重排,检测率为61% (27/44);采用FR1家族特异性引物Mixtures(VH1、VH2、VH3)与J区(JHb、JHc)引物,有34、33例出现克隆性IgH基因重排,检测率为77%、75% (34/44、33/44);结合FR3A、FR2A、FR1家族特异性引物Mixtures(VH1、VH2、VH3),总检测率为95%(42/44).②15例T-NHL有4例出现克隆性IgH基因重排,而5例LRH未出现克隆性IgH基因重排.③1例免疫组化未分型的NHL经PCR检测后明确了分型,为B细胞性淋巴瘤.结论 联合采用多对引物可提高检测阳性率;IgH基因克隆性重排检测对鉴别B细胞淋巴瘤和淋巴结反应性增生以及T细胞淋巴瘤有重要意义.

Analysis of IgH gene rearrangement and its significance in non-Hodgkin lymphoma

Objective To explore the significance of detecting IgH gene rearrangement in diagnosis of non-Hodgkin lymphoma. Methods By using family-specific primers mixtures (VH1,VH2,VH3) for IgH FR3A,FR2A,FR1 genes,clonal IgH gene rearrangement was detected by heminested and multiplex PCR in 44 cases of B-NHL,1 undifferentiated lymphoma,15 T-NHL and 5 lymphonode reactive hyperplasia. Results Clonal IgH gene rearrangement was detected in 36 of 44 B-NHL (positive rate 82%) by using FR3A primers,27 of 44 B-NHL (positive rate 61%) by using FR2A primers. By using FR1 family-specific primers mixtures (VH1,VH2,VH3) and JH (JHb,JHc),clonal IgH gene rearrangement was demonstated respectively in 34/33 of 44 B-NHL (positive rate 77%,75%). The total positive rate was 95% (42/44) by combined family-specific primers mixtures (VH1,VH2,VH3) of FR3A,FR2A,FR1 gene. Four of 15 T-NHL revealed clonal IgH gene rearrangement,while 5 LRH had no clonal IgH gene rearrangement. One NHL unclassified by immunohistochemical methods was classified definitely as B cell-derived lymphoma by PCR. Conclusion The detection rate of IgH gene rearrangement can be improved by combined usage of several pairs of primers,especially family-specific primers. Detecting clonal IgH gene rearrangement is significant in the procedure of differential diagnosis for B/T-NHL and reactive hyperplasia.