Fan He-Bin, Zhu You-Fu, Chen An-Shen, Zhou Mu-Xiu, Yan Fu-Ming, Ma Xiao-Ju, Zhou Hao
Department of Infectious Disease, The People's Liberation Army 161 Hospital, Wuhan, Hubei Province, China.
World J Gastroenterol. 2009 Apr 7;15(13):1636-40. doi: 10.3748/wjg.15.1636.
The association of hepatitis C virus (HCV) infection with type II mixed cryoglobulinemia is well established, but the role of HCV in B-cell lymphoma remains controversial. In patients with HCV infection, B-cell clonal expansions have been detected in peripheral blood and bone marrow, and a high prevalence of B-cell non-Hodgkin's lymphomas has been documented. Liver biopsies in chronic HCV infection frequently show portal lymphoid infiltrates with features of B follicles, whose clonality has not yet been investigated. The object of this study was to determine the frequency of liver-infiltrating monoclonal B-cells in 40 patients with HCV infection.
Eight hundred and forty-eight patients were studied prospectively, including 40 HCV-positive patients and 808 patients with chronic hepatitis B virus (HBV) infection. Immunohistochemical study for B- and T-cell markers was performed on the paraffin-embedded liver tissue sections. The clonality of lymphoid B-cells was tested using a polymerase chain reaction (PCR) approach designed to identify immunoglobulin heavy chain gene (IgH) rearrangements.
Liver-infiltrating monoclonal B-cells were detected in the liver for 4 (10%) of 40 HCV-positive patients but were present in only 3 (0.37%) of 808 liver biopsy specimens with chronic HBV infection. Chi-square testing showed that the monoclonal B-cells infiltration in the liver was more frequent in the HCV-infected patients (P = 0.000). A clonal IgH rearrangement was detected in 5 (71.4%) of 7 liver biopsy specimens with monoclonal B-cells infiltration. In 2 of 5 patients with both a clonal B-cell expansion and monoclonal B-cells infiltration in the liver, a definite B-cell malignancy was finally diagnosed.
Liver-infiltrating monoclonal B-cells are detected in the liver of patients with chronic HCV and HBV infection. A high percentage of patients with monoclonal B-cells infiltration and B-cell clonality in the liver were finally diagnosed as having a definite B-cell malignancy.
丙型肝炎病毒（HCV）感染与II型混合性冷球蛋白血症之间的关联已得到充分证实，但HCV在B细胞淋巴瘤中的作用仍存在争议。在HCV感染患者中，已在外周血和骨髓中检测到B细胞克隆性扩增，并且已记录到B细胞非霍奇金淋巴瘤的高患病率。慢性HCV感染的肝活检经常显示具有B滤泡特征的门静脉淋巴浸润，其克隆性尚未得到研究。本研究的目的是确定40例HCV感染患者中肝浸润性单克隆B细胞的频率。
对848例患者进行前瞻性研究，包括40例HCV阳性患者和808例慢性乙型肝炎病毒（HBV）感染患者。对石蜡包埋的肝组织切片进行B细胞和T细胞标志物的免疫组织化学研究。使用旨在鉴定免疫球蛋白重链基因（IgH）重排的聚合酶链反应（PCR）方法检测淋巴B细胞的克隆性。
40例HCV阳性患者中有4例（10%）在肝脏中检测到肝浸润性单克隆B细胞，但在808例慢性HBV感染的肝活检标本中仅3例（0.37%）存在。卡方检验显示，HCV感染患者肝脏中克隆性B细胞浸润更为常见（P = 0.000）。在7例有单克隆B细胞浸润的肝活检标本中，有5例（71.4%）检测到克隆性IgH重排。在5例肝脏中既有克隆性B细胞扩增又有单克隆B细胞浸润的患者中，最终确诊为明确的B细胞恶性肿瘤。
在慢性HCV和HBV感染患者的肝脏中检测到肝浸润性单克隆B细胞。肝脏中有单克隆B细胞浸润和B细胞克隆性的患者中，有很大比例最终被诊断为明确的B细胞恶性肿瘤。
