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目的探讨免疫球蛋白重链(IgH)基因单克隆性重排的检测对胃MALT淋巴瘤的诊断及鉴别诊断价值。方法应用半巢式聚合酶链反应(semi nestedPCR)技术检测石蜡包埋的31例胃MALT淋巴瘤、26例淋巴细胞性胃炎及11例对照标本免疫球蛋白重链(IgH)基因重排的克隆性。引物选用互补于IgH基因V区及J区保守序列的Fr2,Fr3。结果(1)用Fr3为引物扩增 ,74.2 %的胃MALT淋巴瘤获得单克隆性重排条带 ;联合Fr2扩增 ,可使其检出率提高到87.1 %。(2)对手术及胃镜活检的石蜡包埋标本 ,该技术具有相同的敏感性 ;(3)26.9%的淋巴细胞性胃炎中出乎预料地发现有IgH基因单克隆重排条带。结论用IgH基因引物进行PCR扩增是临床上诊断和鉴别诊断胃MALT淋巴瘤的有效手段。有B细胞单克隆形成的淋巴细胞性胃炎可能系淋巴瘤的前期病变 ,对其进行监测和随访是十分重要的
Objective To investigate the diagnostic and differential diagnosis of gastric MALT lymphoma detected by monoclonal rearrangement of immunoglobulin heavy chain (IgH) gene. Methods Semi-nested PCR was used to detect the clones of 31 cases of gastric MALT lymphoma, 26 cases of lymphocytic gastritis and 11 cases of immunoglobulin heavy chain (IgH) gene rearrangement in control samples Sex. The primers used were Fr2 and Fr3 which are complementary to the conserved sequence of V region and J region of IgH gene. Results (1) With Fr3 primer amplification, 74.2% gastric MALT lymphoma obtained monoclonal rearrangement bands; combined with Fr2 amplification, the detection rate can be increased to 87.1%. (2) paraffin-embedded specimens of surgical and endoscopic biopsy have the same sensitivity; (3) unexpectedly, monoclonal monoclonal rearrangement of IgH gene was found in 26.9% of lymphocytic gastritis. Conclusion PCR amplification using IgH gene primers is an effective method for the diagnosis and differential diagnosis of gastric MALT lymphoma. Lymphocytic gastritis with monoclonal B-cell clones may be a pre-lymphomatous lesion and it is important to monitor and follow up