De Luca A, Antinori A, Cingolani A, Larocca L M, Linzalone A, Ammassari A, Scerrati M, Roselli R, Tamburrini E, Ortona L
Istituti di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy.
Br J Haematol. 1995 Aug;90(4):844-9. doi: 10.1111/j.1365-2141.1995.tb05205.x.
Acquired immunodeficiency syndrome (AIDS)-related primary central nervous system lymphoma (PCNSL) is almost always associated with the Epstein-Barr virus (EBV), and EBV-DNA in cerebrospinal fluid (CSF) has been indicated as a useful tumour marker for this HIV-related neoplasm. AIDS lymphomas also show an enhanced production of IL-10 which is generally associated with the presence of EBV in lymphoma cells. We performed a prospective study in 19 HIV seropositive patients with brain mass lesions, and in 21 other AIDS patients with or without other neurological disorders, to assess the in vivo diagnostic value of EBV-DNA and of IL-10 levels in the CSF for primary lymphoma of the central nervous system (CNS). EBV-DNA was detected by a nested polymerase chain reaction (PCR) in the CSF from seven of eight patients with PCNSL, diagnosed by brain biopsy (87.5% sensitivity) and in none of the 11 controls with brain mass lesions (100% specificity) and of the other 21 AIDS patients with or without neurological disorders. The only patient with PCNSL without detectable EBV-DNA in the CSF was also negative for EBV-DNA in the lymphoma tissue, whereas the samples of the other seven brain lymphomas were all positive for EBV-DNA by nested PCR. Therefore 100% of patients with an EBV-positive primary CNS lymphoma had detectable EBV-DNA in the CSF. No patient from the control group without PCNSL with EBV-negative CSF developed a lymphoma after a mean follow-up of 157 +/- 173 d. IL-10 levels in the CSF from the patients with PCNSL were not significantly different from those in the other groups of patients with AIDS. Due to uniformly high levels in the CSF from AIDS patients, IL-10 is not a useful diagnostic marker for AIDS-related brain lymphoma. The detection of EBV-DNA from the CSF by nested PCR is an extremely sensitive and specific diagnostic tool for AIDS-related PCNSL and should be further evaluated as a possible alternative in patients from whom brain biopsy is not advisable.
获得性免疫缺陷综合征（AIDS）相关的原发性中枢神经系统淋巴瘤（PCNSL）几乎总是与爱泼斯坦-巴尔病毒（EBV）相关，脑脊液（CSF）中的EBV-DNA已被证明是这种与HIV相关肿瘤的有用肿瘤标志物。AIDS淋巴瘤还表现出IL-10产生增加，这通常与淋巴瘤细胞中EBV的存在有关。我们对19例HIV血清阳性且有脑占位性病变的患者以及21例其他有或无其他神经系统疾病的AIDS患者进行了一项前瞻性研究，以评估CSF中EBV-DNA和IL-10水平对中枢神经系统（CNS）原发性淋巴瘤的体内诊断价值。通过巢式聚合酶链反应（PCR）在8例经脑活检诊断为PCNSL的患者中的7例的CSF中检测到了EBV-DNA（敏感性为87.5%），而在11例有脑占位性病变的对照患者以及其他21例有或无神经系统疾病的AIDS患者中均未检测到。CSF中未检测到EBV-DNA的唯一PCNSL患者的淋巴瘤组织中EBV-DNA也为阴性，而其他7例脑淋巴瘤样本通过巢式PCR检测EBV-DNA均为阳性。因此，100%的EBV阳性原发性CNS淋巴瘤患者的CSF中可检测到EBV-DNA。在平均随访157±173天之后，CSF中EBV阴性的无PCNSL的对照组患者均未发生淋巴瘤。PCNSL患者CSF中的IL-10水平与其他AIDS患者组相比无显著差异。由于AIDS患者CSF中的IL-10水平普遍较高，因此IL-10不是AIDS相关脑淋巴瘤的有用诊断标志物。通过巢式PCR从CSF中检测EBV-DNA是诊断AIDS相关PCNSL的一种极其敏感和特异的诊断工具，对于不适合进行脑活检的患者，应进一步评估其作为一种可能替代方法的价值。
