Yi Zhi-hui, Ouyang Qin, Chen Dai-yun, Li Gan-di
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Nei Ke Za Zhi. 2003 Jun;42(6):409-12.
To determine the general markers for the diagnosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma and select optimal cases to be interfered in early stage.
To investigate the changes of histology, Ki-67 expression, monoclonality of IgH gene rearrangement in gastric lymphoid hyperplasia (GLH) cases before and after Helicobacter pylori (Hp) eradication treatment. Histological changes were classified according to Isaacson's criteria of GLH; L26, UCHL-1, anti-Kappa, anti-Lambda and Ki-67 were applied for immunohistochemical staining; semi-nest PCR was used to detect IgH gene rearrangement.
Thirty-one cases of GLH with predominant chronic gastritis and gastric ulcer were studied. The ratio of male to female in the 31 cases was 1.8 and the mean course 6.8 years. Twenty-nine cases had Hp infection. Most of the cases belonged to histological grade II and III. Only 1 case had lambda light chain restriction and 10 cases had monoclonal IgH gene rearrangement. Expression of Ki-67 and monoclonal IgH gene rearrangement were significantly increased with the crescendo of lymphoid hyperplasia grading (P < 0.05). 28 cases were given antibiotics with eradication of Hp in 24 cases and 2 cases had to be given another course of treatment. These cases were followed-up on average for 4.6 months. 18 cases showed complete regression both histologically and endoscopically, 4 cases partial regression and 6 cases no change. Four cases with histological grade II, III had the decrease of expression of Ki-67 and reversed to polyclonal IgH gene rearrangement, while there was no change in 4 cases with histological grade IV.
General considerations of histology, expression of Ki-67 and combined clonality of IgH gene rearrangement help to screen cases which need intervention early and make a diagnosis of gastric MALT lymphoma in early stage. Monoclonal IgH gene rearrangement in cases with histological grade III or IV appears to carry more clinical significance.
确定胃黏膜相关淋巴组织（MALT）淋巴瘤诊断的一般标志物，并选择早期干预的最佳病例。
研究幽门螺杆菌（Hp）根除治疗前后胃淋巴组织增生（GLH）病例的组织学变化、Ki-67表达、IgH基因重排的单克隆性。组织学变化根据Isaacson的GLH标准分类；应用L26、UCHL-1、抗κ、抗λ和Ki-67进行免疫组化染色；采用半巢式PCR检测IgH基因重排。
研究了31例以慢性胃炎和胃溃疡为主的GLH病例。31例中男女比例为1.8，平均病程6.8年。29例有Hp感染。大多数病例属于组织学II级和III级。仅1例有λ轻链限制，10例有单克隆IgH基因重排。Ki-67表达和单克隆IgH基因重排随淋巴组织增生分级升高而显著增加（P<0.05）。28例给予抗生素治疗，24例Hp根除，2例需再次治疗。这些病例平均随访4.6个月。18例组织学和内镜检查均显示完全消退，4例部分消退，6例无变化。4例组织学II级、III级病例Ki-67表达降低，IgH基因重排转为多克隆，而4例组织学IV级病例无变化。
综合考虑组织学、Ki-67表达及IgH基因重排的克隆性有助于早期筛选需要干预的病例并早期诊断胃MALT淋巴瘤。组织学III级或IV级病例的单克隆IgH基因重排似乎具有更大的临床意义。
