Jimmy E O, Bedu-Addo G, Bates I, Bevan D, Rutherford T R
Division of Haematology, St George's Hospital Medical School, London, UK.
Trans R Soc Trop Med Hyg. 1996 Jan-Feb;90(1):37-9. doi: 10.1016/s0035-9203(96)90472-1.
Hyperreactive malarial splenomegaly (HMS) is found in geographical association with B cell lymphoproliferative disorders such as 'African' chronic lymphocytic leukaemia (CLL) and splenic lymphoma with villous lymphocytes (SLVL). It is sometimes not easy to make a differential clinical diagnosis between these conditions. We have previously used Southern blotting as a definitive method for the diagnosis of monoclonal lymphoproliferation in these disorders, but this is expensive, lengthy and technically difficult. In the present paper we have compared Southern blotting with polymerase chain reaction (PCR) amplification of the immunoglobulin heavy chain gene. We found an excellent correlation between the 2 methods in demonstrating monoclonal populations of lymphocytes in patients with a clinical diagnosis of CLL or SLVL. We have further demonstrated monoclonality in a patient who could not be classified as CLL or SLVL on clinical criteria alone. In contrast, patients with well defined HMS or with non-B cell proliferations all showed polyclonal rearrangements. We propose that the immunoglobulin gene PCR is a useful tool for the investigation of tropical splenomegaly of uncertain origin.
高反应性疟疾性脾肿大（HMS）在地理分布上与B细胞淋巴增殖性疾病相关，如“非洲型”慢性淋巴细胞白血病（CLL）和伴有绒毛淋巴细胞的脾淋巴瘤（SLVL）。有时，在这些疾病之间做出鉴别临床诊断并不容易。我们之前曾使用Southern印迹法作为诊断这些疾病中克隆性淋巴增殖的确定性方法，但该方法昂贵、耗时且技术难度大。在本文中，我们将Southern印迹法与免疫球蛋白重链基因的聚合酶链反应（PCR）扩增进行了比较。我们发现，在临床诊断为CLL或SLVL的患者中，这两种方法在显示淋巴细胞单克隆群体方面具有极好的相关性。我们还在一名仅根据临床标准无法归类为CLL或SLVL的患者中进一步证实了单克隆性。相比之下，明确诊断为HMS的患者或非B细胞增殖患者均显示多克隆重排。我们认为，免疫球蛋白基因PCR是调查来源不明的热带脾肿大的有用工具。
