【摘要】 目的：分析成熟T细胞淋巴瘤（TCL）和意义未明的克隆性T细胞（T-CUS）的免疫表型及临床特点，探索流式细胞术在TCL与T-CUS鉴别诊断中的应用价值。方法：通过多参数流式细胞术（MFC）分析并比较2019年10月至2024年6月河南省人民医院血液科收治的93例TCL患者（TCL组）、46例检测出反应性克隆性T淋巴细胞患者（T-CUS组）的免疫表型特征，同时收集TCL组与T-CUS组患者的临床及实验室资料。结果：流式流式细胞术检测结果显示，TCL组与T-CUS组患者具有相似的免疫表型，均以CD8~+异常表型T细胞最多，CD4~+次之，CD4~+/CD8~+双阳性和CD4~-/CD8~-双阴性罕见。两组CD3、CD4、CD8的阳性表达率具有明显的统计学差异，TCL组患者的CD3表达率（72.00±42.04）和CD8表达率（56.04±48.22）低于T-CUS组（94.05±21.61,79.86±36.33,P<0.05），而CD4表达率（38.35±48.53）则高于T-CUS组（10.76±31.15）(P<0.01)。TRBC1在所有TCL和T-CUS病例中均呈限制性表达模式，TCL组TRBC1阳性表达率略高于T-CUS组，但两者之间差异无显著统计学意义（P>0.05）。TCL组患者的红细胞平均分布宽度（RDW-CV）和血清乳酸脱氢酶（LDH）水平分别为17.6(11.9-24)、459(129-90704)，均明显高于T-CUS组的14.1(10.9-19.1)、310(99-11722)(P<0.05)。统计两组病例可获得的TCR基因重排结果，用Kappa检验统计分析，结果显示，TCL组TCR基因重排阳性率（92.1%）明显高于T-CUS组（52.6%），且差异有统计学意义（P<0.001）。结论：TRBC1可以作为快速检测T细胞克隆性的理想指标，MFC联合TCR基因重排检查对鉴别TCL和T-CUS有较好的临床价值。更多还原

【Abstract】 Objective:To analyze the immunophenotype and clinical characteristics of mature T-cell lymphoma（TCL） and clonal T cells of undetermined significance（T-CUS）,and to explore the application value of flow cytometry in the differential diagnosis of TCL and T-CUS.Methods:Multi-parameter flow cytometry（MFC） was used to analyze the immunophenotypic characteristics of 93 TCL patients（TCL group） and 46 patients with T-CUS but no Tlymphoproliferative disease（non-TCL group） admitted to the Department of Hematology of Henan Provincial People’s Hospital from October 2019 to June 2024,and the clinical and laboratory data of patients in TCL group and T-CUS group（non-TCL patients） were collected.Results:In terms of flow cytometry immunophenotype,the TCL group and the TCUS group had similar immunophenotypes,with CD8+tumor cells being the most,followed by CD4⁺,and CD4⁺/CD8⁺ and CD4^-/CD8^-being rare.There were significant statistical differences in the positive expression rates of CD₃,CD4 and CD8 between the two groups,which showed that the expression rates of CD3 and CD8 in the TCL group were lower than those in the T-CUS group（CD3:72.00±42.04 vs.94.05±21.61;CD8:56.04±48.22 vs.79.86±36.33）（P<0.05）,while the expression rates of CD4 were higher than those in the T-CUS group [（38.35±48.53）vs.（10.76±31.15）,（P<0.01）].TRBC1 showed a restricted expression pattern（monoclonal expression） in all cases,and the positive expression rate of TRBC1 in the TCL group was slightly higher than that in the T-CUS group,but there was no significant statistical difference between the two group（P> 0.05）.According to the laboratory results,the levels of RDW-CV and LDH in the TCL group were higher than those in the T-CUS group [RDW-CV:17.6（11.9-24） vs.14.1（10.9-19.1）;LDH:459（129-90 704） vs.310（99-11 722）],and the difference was statistically significant（P <0.05）.The results of T-cell receptor（TCR） gene rearrangement,karyotype analysis and EBV nucleic acid quantitative detection were obtained in the two groups,and the Kappa test showed that the positive rate of TCR gene rearrangement in the TCL group was significantly higher than that in the T-CUS group（92.1% vs.52.6%）（P <0.001）.Conclusion:TRBC1 can be used as an ideal indicator for rapid detection of T cell clonality,Multi-parameter flow cytometry（MFC） combined with TCR gene rearrangement testing has good clinical value in distinguishing T-cell lymphoma from T-cell clonal proliferation of uncertain significance.更多还原