88例恶性淋巴瘤预后相关资料分析

目的：了解恶性淋巴瘤（ML）发病、病理及免疫分型特点，探讨基因分型在诊断中的作用。方法：通过标准链菌素生物素－过氧化物酶标记物法（SABC法）对病理标本进行免疫分型，PCR检测病理及骨髓标本IgH（FR2A，3A）和TCR（β，γ）基因重排，同时对临床及病理资料进行多因素分析。结果：（1）ML非霍奇金淋巴瘤（NHL）较霍奇金淋巴瘤（HL）发病率高，发病率随年龄增长而递增，60岁以上发病者占38．6％；其平均生存时间明显低于60岁以下者。（2）B－NHL发病率为68．6％，T－NHL为28．6％；B－NHL的3年生存率高于T－NHL。（3）低度恶性NHL占42％，中、高度恶性占58％；低度恶性组平均生存时间较中、高度恶性组长，但统计学上差异无显著性。生存期分析显示I－Ⅱ期NHL预后明显优于Ⅲ－Ⅳ期。（4）PCR检测病理及骨髓标本的IgH和TCR重排，B－NHL FR2A的阳性率分别为66.7%及56．2％；FR3A阳性率分别为90．4％及81．2％；T－NHL中TCRβ、γ阳性率分别为91．7％及75．0％；病理标本的阳性率略高于骨髓，T、B分型与免疫分型相符。结论：年龄，T、B分型和临床分期是影响NHL预后的重要因素；分子生物学检测作为辅助手段可以肯定免疫分型结果并补充其不足，骨髓及外周血检测除协助分型外可用于肿瘤微小残留病的监测。

Lymphoma prognostic correlated factors analysis of 88 cases

OBJECTIVE: To analyze the characters of incidence, pathological and immunological phenotype of malignant lymphoma(ML), and to study the significance of IgH and TCR T cell receptor gene rearrangement for NHL typing. METHODS: Immunological phenotyping was conducted by SABC, and IgH (FR2A, FR3A) & TCR (beta,gamma) gene rearrangement detected by PCR of some pathological wax and bone marrow samples. RESULTS: (1) In ML, the percentage of non-Hodgkin lymphoma, (NHL) was 88.6% and Hodgkin lymphoma (HL) was 11.4%. The incidence increased with the patient's age. The percentage of patients over 60 years was 38.6%, and the median survival time of those older than 60 years was significantly shorter than that of the younger. (2) The percentage of B-NHL was 68.6%, and that of T-NHL was 28.6%; 3 years' survival time rate of B-NHL was higher than that of T-NHL. (3) The percentage of low grade NHL was 42%, and that of middle and high grade NHL was 58%; and the overall survival time was not significantly different between the two groups. But the overall survival time was longer in patients in stages I-II than in stages III-IV. (4) The results of detection on wax and bone marrow samples showed that B-NHL FR2A were 66.7% and 56.2% positive, FR3A 90.4% and 81.2% positive; in T-NHL patients, TCR-beta and TCR-gamma gene rearrangements were 91.7% and 75.0% positive; T and B classification were the same as the immunological phenotype. CONCLUSION: Age, T and B classifications and staging are the important factors, which affect the prognosis of NHL. Molecular biological methods can help T/B classification when we couldn't get it by phenotyping.