高免疫球蛋白血症型多发性骨髓瘤与轻链型多发性骨髓瘤临床及实验室指标综合分析  

Clinical and laboratory analysis of multiple myeloma of hyperimmunoglobulinemia type and light chain type

作　　者：白志瑶 尹春琼 包艳 戴宏斌 李晓东 朱星成 Bai Zhiyao;Yin Chunqiong;Bao Yan;Dai Hongbin;Li Xiaodong;Zhu Xingcheng(Department of Laboratory,Qujing Second People's Hospital,Qujing 655000,Yunnan,China)

机构地区：[1]曲靖市第二人民医院检验科,云南曲靖655000

出　　处：《实用检验医师杂志》2020年第2期90-94,共5页Chinese Journal of Clinical Pathologist

摘　　要：目的分析多发性骨髓瘤(MM)中高免疫球蛋白血症型与轻链型的实验室相关指标及临床特征,了解高免疫球蛋白血症型MM与轻链型MM的发病特点,以减少临床及实验室误诊、漏诊。方法选择曲靖市第二人民医院2014年5月-2019年12月诊断的28例高免疫球蛋白血症型MM患者(高Ig MM组)与18例轻链型MM患者(轻链型MM组)作为研究对象。收集两组患者的发病年龄及性别分布、临床症状、首诊入院科室、贫血类型等临床资料;采用骨髓细胞涂片观察两组患者原始和幼稚细胞形态学及比例;采用血细胞分析仪进行血液细胞分析,采用全自动生化仪检测血清总蛋白(TP)、白蛋白(ALB)、球蛋白(GLB),采用全自动电泳分析仪和配套试剂进行血清蛋白电泳和免疫固定电泳检测;采用特定蛋白仪及配套试剂进行免疫球蛋白(IgG、IgA、IgM)、血κ轻链(κ)、血λ轻链(λ)定量检测。对两组的临床资料及实验室检查资料进行对比分析。结果高Ig MM组与轻链型MM组的发病年龄、性别分布比较差异无统计学意义(P>0.05);两组患者的贫血类型以中度和轻度正细胞贫血最多见,首诊入院科室以血液科最多见,临床症状以骨质疏松、骨痛、骨质破坏最多见,差异均无统计学意义(均P>0.05)。高Ig MM组和轻链型MM组骨髓涂片均检出原始和幼稚浆细胞,两组比例比较差异无统计学意义(P>0.05);血清蛋白电泳均检出单克隆免疫球蛋白(M蛋白),高Ig MM组比例明显高于轻链型MM组〔(46.75±13.87)%比(18.10±13.85)%〕,差异有统计学意义(P<0.05)。实验室检查中高Ig MM组TP、GLB、IgG、IgA、κ、λ均明显高于轻链型MM组〔TP(g/L):93.13±16.99比60.80±4.66,GLB(g/L):64.30±16.30 比24.39±7.39,IgG(g/L):58.76±22.73比5.57±3.77,IgA(g/L):41.39±24.26比1.91±0.90,κ(g/L):22.27±11.49比4.47±1.78,λ(g/L):15.26±6.27比3.94±3.62〕;ALB明显低于轻链型MM组(g/L:27.72±4.82比36.41±5.59),差异均有统计学意义(均Objective To analyze the laboratory indexes and clinical characteristics of multiple myeloma(MM)of hyperimmunoglobulinemia type and light chain type,and understand the onset characteristics of hyperimmunoglobulinemia MM and light chain MM,so as to reduce clinical and laboratory misdiagnosis and missed diagnosis.Methods The 28 cases with hyperimmunoglobulinemia MM(high Ig MM group)and 18 cases with light chain MM(light chain MM group)diagnosed in Qujing Second People's Hospital from May 2014 to December 2019 were selected as research objects.The clinical data such as onset adg,gender distribution,clinical symptoms,department of admission at the first diagnosis and anemia type were collected for comparative analysis.The morphology and proportion of primitive and immature cells of two groups were observed by bone marrow cell smear;the serum total protein(TP),albumin(ALB)and globulin(GLB)were detected using automatic biochemical analyzer;blood cell analysis was carried out by blood cell analyzer;automatic electrophoresis analyzer and matching reagents were used for serum protein electrophoresis and immunofixation electrophoresis;the immunoglobulins(IgG,IgA,IgM), chain( )andλchain(λ)were detected by specific protein instrument and matching reagents.Results There was no significant difference in age and gender distribution between high Ig MM group and light chain MM group(both P>0.05).The most common type of anemia was moderate and mild positive cell anemia;Department of Hematology was the most common department in the first hospital visit;the most common clinical symptoms were osteoporosis,bone pain and bone destruction.There was no significant difference among above indexes between the two groups(all P>0.05).In high Ig MM and light chain MM groups,100%of the bone marrow smear showed primitive and immature plasma cells,without significant difference in the proportion(P>0.05).Serum protein electrophoresis detected monoclonal protein(M protein)in both groups,the average proportion of M protein in high Ig MM group was

关 键 词：多发性骨髓瘤 骨髓涂片 血清蛋白电泳 免疫固定电泳 

分 类 号：R733.3[医药卫生—肿瘤]