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背景与目的:骨髓是恶性淋巴瘤发展过程中较易累及的结外器官,常规的检测方法包括骨髓活检和骨髓穿刺,但各有其优缺点,流式细胞术(F low Cytom etry,FCM)是近几十年来发展的新型细胞检测技术,在国外已经较广泛的应用于恶性淋巴瘤的诊断和鉴别诊断。本研究拟探讨FCM在检测B细胞淋巴瘤骨髓侵犯中的可行性及有效性,并初步评价其临床病理价值。方法:采用CD45-SSC设门联合三种不同荧光标记的抗CD45、CD5、CD10、CD19、CD20、CD22、CD23、CD43、FMC-7、λ和κ抗体在流式细胞仪上对79例B细胞淋巴瘤患者骨髓进行检测,与骨髓细胞形态学检测比较。结果:①在79例B细胞淋巴瘤患者中,用FCM检测出35例(44.3%)患者有侵犯,而骨髓细胞形态学只检测出16例(20.3%),两者有显著性差异(P<0.05);符合率为60/79(75.9%)。②用FCM检测,弥漫大B细胞性淋巴瘤(DLBCL)、滤泡性淋巴瘤(FL)及小淋巴细胞性淋巴瘤(SLL)患者在初诊时的侵犯率分别为20.0%、43.8%和100%。③FCM结果阳性率和Ann Arbor分期有明显关系,在分期晚的患者FCM阳性机会高(P<0.001),有B组症状及复治的患者中FCM检出骨髓侵犯高于相应的组别,但未显示统计学意义(P>0.05),与LDH水平和脾脏累及与否无相关(P>0.05)。④对未确定具体类型的4例骨髓侵犯患者,根据免疫表型能够确定诊断。结论:FCM是检测B细胞淋巴瘤骨髓侵犯的有效方法,较骨髓细胞形态学敏感;且能够起到辅助诊断的作用;对不同类型淋巴瘤初治患者骨髓侵犯与临床表现、治疗反应的相关性尚需扩大病例进一步研究。
BACKGROUND & OBJECTIVE: Bone marrow is a more accessible extranodal organ in the development of malignant lymphoma. Conventional detection methods include bone marrow biopsy and bone marrow aspiration, but each has its own advantages and disadvantages. Flow cytometry (FCM) Is a new type of cell detection technology developed in recent decades. It has been widely used in the diagnosis and differential diagnosis of malignant lymphoma in foreign countries. This study was to investigate the feasibility and effectiveness of FCM in the detection of bone marrow invasion of B-cell lymphoma and to evaluate its clinicopathological value. Methods: CD45-SSC combined with three different fluorescent labeled anti-CD45, CD5, CD10, CD19, CD20, CD22, CD23, CD43, FMC-7, λ and κ antibodies on flow cytometry 79 cases of B Bone marrow cell lymphoma patients were detected, compared with bone marrow cell morphology. RESULTS: ①In 79 patients with B-cell lymphoma, 35 (44.3%) were detected by FCM, and 16 (20.3%) were detected by bone marrow morphology. There was a significant difference between the two <0.05). The coincidence rate was 60/79 (75.9%). ② The rates of infringement in newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and small lymphocytic lymphoma (SLL) by FCM were 20.0%, 43.8% and 100% %. The positive rate of FCM was significantly correlated with Ann Arbor staging. The positive chances of FCM were higher in patients with late stage (P <0.001), and those in group B with symptom and retreatment were higher than those in corresponding group No statistical significance (P> 0.05), and LDH levels and spleen involvement or not (P> 0.05). ④ Not sure about the specific type of bone marrow invasion in 4 patients, according to the immune phenotype can determine the diagnosis. CONCLUSION: FCM is an effective method to detect bone marrow invasion of B-cell lymphoma, which is more sensitive than that of bone marrow cells and can play an auxiliary role in diagnosis. The correlation between bone marrow invasion and clinical manifestation and treatment response in patients with different types of lymphoma Still need to expand the case for further study.