IgM型单克隆免疫球蛋白阳性107例临床特征分析  

Monoclonal IgM disease:a retrospective analysis of 107 cases

作　　者：赵磊[1] 徐双[1] 裴林[1] 夏长胜[1] 王辉[1] 路瑾[2] 黄晓军[2] 

机构地区：[1]北京大学人民医院检验科,北京100044 [2]北京大学血液病研究所,北京100044

出　　处：《中国实用内科杂志》2016年第2期137-140,共4页Chinese Journal of Practical Internal Medicine

基　　金：科技部重大专项创新药物研究开发技术平台建设(2012ZX0903019)

摘　　要：目的提高对IgM型单克隆免疫球蛋白阳性的鉴别诊断,减少漏诊与误诊。方法收集2007年9月至2014年9月北京大学人民医院IgM型单克隆免疫球蛋白阳性患者107例,分析病种分布及临床特征,并检测频率最高的5种疾病的免疫球蛋白、β_2微球蛋白(β_2MG)水平及华氏巨球蛋白血症(WM)患者免疫表型。结果 107例患者中,主要为WM(51.4%,55例),其次边缘带淋巴瘤(15.9%,17例),意义未明的单克隆球蛋白增多症(10.3%,共11例),1例免疫缺陷病。不同疾病组间IgM水平、IgA水平及β_2MG水平差异有统计学意义(均P<0.05)。IgM水平WM组最高,为32.9(18.3,59.3)g/L。55例WM患者免疫表型sIg阳性100%、CD20阳性100%,CD19阳性95.9%,CD5阳性7.4%、CD10阳性11.5%、CD23阳性32%。结论免疫球蛋白含量以及β_2MG水平可为WM与其他伴IgM型单克隆免疫球蛋白B细胞疾病鉴别诊断提供帮助,免疫分型是诊断该类疾病的主要手段。Objective To improve the differential diagnosis of the disease associated with monoclonal IgM, and reduce the missed diagnosis and misdiagnosis, we analyzed 107 cases with monoclonal IgM positive. Methods Patients with IgM positive who was first diagnosed by serum immunofixation electrophoresis from September in 2007 to September in 2014 in Peking University People＇s Hospital were collected to analysze clinical features and distributions of the disease. The levels of immunoglobulin, β2 microglobulin, and immune phenotype of.Waldenstrom macroglobulinemia（WM） associated with five most frequency diseases were tested. Results Among the 107 cases, 55 cases were WM （51.4%）, 17 cases were marginal zone lymphoma （15.9%）, 11 cases were monoclonal gammopathy of undetermined significance, 1 case was immunodeficiency disease. The levels of IgM, IgA and β2MG had a significant difference among different disease groups （respectively P〈 0.05）. The IgM had a highest level in WM group, which was 32.9 （18.3, 59.3） g/L. Among the 55 WM cases, all of these cases were slg positive（100%）, the cases with CD20 positive accounted for 100%, the cases with CD19 positive accounted for 95.9%, the cases with CDS positive accounted for 7.4%, the cases with CD10 positive accounted for 11.4%, and the cases with CD23 positive accounted for 32%, respectively; Conclusion Analysis ofimmunoglobulin and β2GM levels could help distinguish WM from other IgM positive B-lymphocytes diseases. Immunophenotyping is the main method for diagnosis of these diseases.

关 键 词：单克隆IgM 原发性巨球蛋白血症 免疫球蛋白水平 免疫表型分型 

分 类 号：R595.7[医药卫生—内科学]