轻链表达缺失的IgD型多发性骨髓瘤免疫表型分析  

Immunophenotypic Analysis of IgD Multiple Myeloma with Loss of Light Chain Expression

作　　者：王金行[1] 姜繁明 刘柏新[1] 宋鉴清[1] 刘宇思 WANG Jinhang,JIANG Fanming,LIU Baixin,SONG Jianqing,LIU Yusi(Department of Laboratory Medicine, The First Hospital, China Medical University, Shenyang 110001, Chin)

机构地区：[1]中国医科大学附属第一医院检验科,沈阳110001

出　　处：《中国医科大学学报》2018年第7期577-580,共4页Journal of China Medical University

基　　金：国家自然科学基金(31700804)

摘　　要：目的探讨临床少见的轻链表达缺失的IgD型多发性骨髓瘤(MM)患者实验室检查特点。方法回顾性分析中国医科大学附属第一医院2015年6月至2017年5月收治的55例IgD型MM患者的临床资料。结果IgD型MM患者阳性检出率约占同期MM患者的4.1%,λ型轻链所占比例均高于同期其他类型MM,差异有统计学意义(P<0.05);55例IgD型MM患者中有49例为λ轻链型IgD型(89.1%,49/55),而κ轻链型IgD型仅1例(1.8%,1/55),轻链表达缺失IgD型5例(9.1%,5/55)。轻链表达缺失与完整IgD型MM患者的IgG、IgA和IgM含量均正常或降低。5例轻链表达缺失IgD型MM患者血清蛋白电泳无M峰出现,2例尿本周蛋白阳性。55例MM患者IgD泳道均有特异性的抗原抗体沉淀带,5例轻链表达缺失IgD型MM患者,轻链κ、λ泳道无抗原抗体沉淀带。结论临床初诊疑似MM和IgD型MM复诊患者进行免疫固定电泳时务必加IgD泳道,以避免将IgD型MM误诊为轻链型MM或将轻链表达缺失IgD型MM患者漏诊。Objective To characterize rare IgD multiple myeloma（MM） patients with loss of light chain. Methods Retrospective analysis was conducted for 55 IgD MM patients hospitalized in the First Hospital of China Medical University from June 2015 to May 2017. Results IgD MM positive rate was approximately 4.1%,whereas the proportion of λ light chain was significantly higher than that of other types in the same period（P 〈0.05）. Among 55 IgD MM,49 were λ light chain（89.1%,49/55）,only one was κ light chain（1.8%,1/55）,and five were loss of light chain（9.1%,5/55）. Ig G,Ig A,and Ig M expression were all normal or decreased in IgD MM with loss of light chain and complete IgD MM. Five IgD MM patients with loss of light chain had no monoclonal protein peak,of which two patients were urinary Bence Jones protein positive. All 55 patients had specific antigen-antibody precipitation in the IgD lane;however,five IgD MM with loss of light chain had no precipitation in the light chain lane. Conclusion For newly diagnosed MM patients and IgD-diagnosed MM patients,immunofixation electrophoresis of IgD should be included to avoid misdiagnosis of IgD MM as light chain MM or a missed diagnosis of IgD MM with loss of light chain.

关 键 词：多发性骨髓瘤 免疫球蛋白 轻链缺失 免疫固定电泳 

分 类 号：R733.3[医药卫生—肿瘤]