弥漫大B细胞淋巴瘤患者骨髓中淋巴瘤相关巨噬细胞数量变化及临床意义

摘要

目的 探讨弥漫大B细胞淋巴瘤(DLBCL)患者骨髓中淋巴瘤相关巨噬细胞(LAM)数量变化及临床意义.方法 选取DLBCL患者40例(DLBCL组),其中进展期15例、稳定期25例,淋巴瘤国际预后指数(IPI)评分0~1分29例、≥2分11例;体检健康者18例(对照组).采用流式细胞仪检测两组骨髓中M2型巨噬细胞(即LAM)比例及M2/M1,采用RT-PCR法检测骨髓单个核细胞CC类趋化因子22(CCL22)相对表达量.采用Pearson相关分析法分析骨髓中M2型巨噬细胞比例与CCL22相对表达量及血清乳酸脱氨酶(LDH)、β2微球蛋白(β2-MG)水平的关系.结果 DLBCL组及对照组骨髓中M2型巨噬细胞比例分别为(11.38±1.23)%、(4.53±0.83)%,两组比较P<0.05;M2/M1分别为0.75±0.08、0.61±0.07,两组比较P<0.05.DLBCL组、对照组骨髓单个核细胞CCL22 mRNA相对表达量分别为4.64±0.73、2.12±0.76,两组比较P<0.05.DLBCL组进展期患骨髓中M2型巨噬细胞比例及骨髓单个核细胞CCL22 mRNA相对表达量均高于稳定期患者(P均<0.05),IPI评分0~1分者两项指标均低于IPI ≥2分者(P<0.05),Ann ArborⅠ~Ⅲ期者两项指标均低于Ⅳ期者(P<0.05),有B症状者两项指标均高于无B症状者(P<0.05).DLBCL患者骨髓中M2型巨噬细胞比例与骨髓单个核细胞CCL22相对表达量及血清LDH、β2-MG水平均呈正相关(r分别为0.37、0.49、0.42, P均<0.05).结论 DLBCL患者骨髓中LAM数量增加与肿瘤发生、发展、疗效及患者预后均有关,并可反映肿瘤负荷;促进CCL22表达可能是其作用机制.%Objective To investigate the levels of lymphoma-associated macrophages (LAM) in bone marrow of patients with diffuse large B-cell lymphoma (DLBCL) and its clinical significance.Methods Forty DLBCL patients (DLBCL group) and 18 healthy controls (NC group) were enrolled in the study.M2 macrophages (LAM) in the bone marrow and the ratio of M2 to M1 (M2/M1) in the two groups were detected by flow cytometry (FCM).C-C motif chemokine 22 (CCL22) mRNA expression was analyzed using RT-PCR.The relationship between the percentage of M2 macrophages in bone marrow and CCL22mRNA, lactate dehydrogenase (LDH), β2 microglobulin (β2-MG) was analyzed by Pearson correlation analysis.Results The M2 percentages in the DLBCL group and NC group were 11.38%±1.23% and 4.53%±0.83% , respectively (P<0.05).The M2/M1 ratios in the DLBCL group and NC group were 0.75±0.08 and 0.61±0.07, respectively (P<0.05).The CCL22 mRNA expression in the bone marrow mononuclear cells of the DLBCL group and NC group was 4.64±0.73 and 2.12±0.76, respectively (both P<0.05).The M2 percentage and M2/M1 ratio and the CCL22 mRNA expression in the bone marrow mononuclear cells of patients with initial treatment and progression of disease (PD) were higher than those in the effectively treated and stable disease (SD) patients (both P<0.05).The M2 percentage in the IPI score 0-1 group was lower than in the IPI score ≥2 group (P<0.05).The M2 percentage in stage I-III patients was lower than that in the stage Ⅳ patients (P<0.05).The M2 percentage in patients with B symptom was higher than in patients without B symptom (P<0.05).There were positive correlations between the M2 percentage and the CCL22 mRNA expression, LDH level and β2-MG level (r=0.37, 0.49, 0.42, all P<0.05).Conclusion The increased amount of LAM in bone marrow of patients with DLBCL is related to disease progression, curative effect and prognosis, which can reflect the tumor burden and promote the expression of CCL22.