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目的 探讨免疫球蛋白重链(IgH)和T细胞受体γ(TCRγ)基因重排在急性非淋巴细胞白血病(ANLL)患者中的临床意义。方法 用聚合酶链反应 (PCR)检测50例ANLL患者骨髓、外周血单个核细胞(MNCs)中克隆性IgH、TCRγ基因重排。结果 克隆性IgH和/或TCRγ基因重排在50例ANLL中检出率为32.0 % (16/50) ,其中IgH为28.0% (14/50) ,TCRγ为16.0 % (8/50)。1例反应性淋巴结炎和20例正常人均未检测到IgH和TCRγ基因重排。27例非M3 初发ANLL患者经DA或HA标准方案化疗 ,10例基因重排阳性的患者1疗程后获完全缓解3例 (30.0% ) ,而17例基因重排阴性患者1疗程后完全缓解13例 (76.5 % ) ,两者差别具有显著性意义 (P<0.05)。结论 (1)IgH、TCRγ基因重排不仅出现于淋巴细胞来源的肿瘤 ,也可见于部分ANLL患者;(2)出现IgH和/或TCRγ基因重排可能是ANLL患者预后不佳的指标之一。
Objective To investigate the clinical significance of immunoglobulin heavy chain (IgH) and T cell receptor γ (TCRγ) gene rearrangements in patients with acute non-lymphocytic leukemia (ANLL). Methods The clonal IgH and TCRγ gene rearrangements in bone marrow and peripheral blood mononuclear cells (MNCs) from 50 patients with ANLL were detected by polymerase chain reaction (PCR). Results The clonality of IgH and / or TCRγ gene rearrangements was 32.0% (16/50) in 50 cases of ANLL, of which IgH was 28.0% (14/50) and TCRγ was 16.0% (8/50). IgH and TCRγ gene rearrangements were not detected in 1 reactive lymphadenitis and 20 normal controls. Twenty-seven patients with non-M3 primary ANLL were treated with standard chemotherapy of DA or HA. Ten patients with positive gene rearrangement achieved complete remission in 3 (30.0%) patients after one course of treatment, while 17 patients with negative gene rearrangement achieved complete remission after one course of treatment 13 cases (76.5%), the difference between the two groups was significant (P <0.05). Conclusions (1) IgH and TCRγ gene rearrangements are not only found in lymphoid-derived tumors, but also in some patients with ANLL. (2) The occurrence of IgH and / or TCRγ gene rearrangements may be one of the indicators of poor prognosis in patients with ANLL.