多发性骨髓瘤伴肾损害患者肾脏病理及细胞遗传学检查的回顾性分析  

Renal Pathology and Cytogenetic Examination in Multiple Myeloma Patients with Renal Impairment——Retrospective Analysis

作　　者：吕佳 贺扬欣 王锦程 孙吉平[1] 解立怡[1] 贺鹏程[2] 陈颖[2] LYU Jia;HE Yang-Xin;WANG Jin-Cheng;SUN Ji-Ping;XIE Li-Yi;HE Peng-Cheng;CHEN Ying(Department of Nephrology,Nephrology Hospital,The First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,Shaanxi Province,China;Department of Hematology,The First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,Shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院肾脏病医院肾脏内科,陕西西安710061 [2]西安交通大学第一附属医院血液内科,陕西西安710061

出　　处：《中国实验血液学杂志》2020年第4期1272-1277,共6页Journal of Experimental Hematology

基　　金：陕西省重点研发计划项目(2018SF-045)。

摘　　要：目的:探讨多发性骨髓瘤伴肾损害患者肾脏病理及细胞遗传学特点。方法:回顾性分析本院2009年1月-2019年1月初诊多发性骨髓瘤伴肾损害并行肾穿刺患者的临床资料,并且分析骨髓荧光原位杂交检查(Fluorescence in situ hybridization,FISH)结果与肾脏病理检查结果之间的关系,采用SPSS 20.0进行统计分析。结果:行肾穿刺活检患者20例,其中男性12例,女性8例。20例患者中间质性肾炎7例,其中3例FISH检查阴性,其余IgH重排、1q21扩增、RB1缺失、D13S319缺失和P53缺失检出率分别为42.86%、28.57%、28.57%、28.57%和14.29%,与总体探针阳性检出率相比显著降低(P<0.01);管型肾病6例,其中IgH重排、1q21扩增、RB1缺失、D13S319缺失、P53缺失检出率分别为66.67%、50%、66.67%、50%和0,与总体探针阳性率相比无统计学意义(P>0.05);急性肾小管损伤4例,IgH重排、1q21扩增、RB1缺失、D13S319缺失、P53缺失检出率分别为100%、50%、50%、25%和25%,与总体探针阳性率相比无统计学意义(P>0.05);淀粉样变及管型肾病合并淀粉样变各1例,均为5种探针检测为阳性;轻链沉积病1例为RB1基因缺失+D13S319基因缺失阳性。结论:不同肾脏病理损伤的患者FISH表现出异质化特点,可用其预测肾损害风险及推测可能的肾脏病理类型以指导预后。Objective:To explore the renal pathology and cytogenetic features in the multiple myeloma(MM)patients with renal impairment.Methods:The clinical data of newly diagnosed MM patients with renal impairment in our hospital from January 2009 to January 2019 were analyzed retrospectively,and the relationship between FISH results and results of renal pathological exanimation was analyzed statistically by using SPSS 20.0.Results:A total of 20 patients underwent renal biopsy,included 12 males and 8 females.FISH result showed that out of 20 patients,7 cases presented interstitial nephritis,among which 3 cases were negative for FISH,and in the remaining cases the rate of IgH rearrangement,1q21 amplification,RB1 deletion,D13S319 deletion,and P53 deletion detection was 42.86%,28.57%,28.57%,28.57%and 14.29%respectively,the detection positive rate was statistically significantly lower as compared with total probe positive rate(P<0.01).There were 6 cases of cast nephropathy,among which IgH rearrangement,the rate of 1q21 amplification,RB1 deletion,D13S319 deletion,and P53 deletion detection was 66.67%,50%,66.67%,50%and 0%respectively.Compared with the total probe positive rate,there was no statistical significance(P>0.05).There were 4 cases of acute tubular necrosis,among which the detection rates of IgH rearrangement,1q21 amplification,RB1 deletion,D13S319 deletion,and P53 deletion was 100%,50%,50%,25%and 25%,respectively.Compared with the total probe positive rate,there was no statistical significance(P>0.05).There were one case of amyloidosis,and one case of tubular nephropathy with amyloidosis,the detection with 5 probes were all positive.One case of light chain deposition disease was positive for RB1 gene deletion+D13S319 gene deletion.Conclusion:FISH in the MM patients with different renal pathological changes is characterized by heterogeneity,which can be used to predict the risk of renal damage and speculate possible renal pathological types to guide prognosis.

关 键 词：多发性骨髓瘤 肾损害 肾穿刺病理 骨髓荧光原位杂交检查 

分 类 号：R733.3[医药卫生—肿瘤]