骨髓浆细胞形态学检查对浆细胞骨髓瘤患者诊断及预后价值  

Diagnostic and prognostic value of bone marrow plasma cell morphology in patients with plasma cell myeloma

作　　者：吕娟[1] 陶中飞 李莎 宗红[1] 霍虹[1] 马国斌[1] 马璐[1] 赵燕田[1] Lyu Juan;Tao Zhongfei;Li Sha;Zong Hong;Huo Hong;Ma Guobin;Ma Lu;Zhao Yantian(Department of Clinical Laboratory,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China;Department of Hematology,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院检验科,北京100020 [2]首都医科大学附属北京朝阳医院血液科,北京100020

出　　处：《中华检验医学杂志》2023年第5期473-482,共10页Chinese Journal of Laboratory Medicine

基　　金：北京市自然科学基金(7214235)。

摘　　要：目的探讨骨髓浆细胞形态学检查在浆细胞骨髓瘤(PCM)诊断及预后评估中的应用价值。方法观察性研究。收集首都医科大学附属北京朝阳医院2017年1月1日至2022年2月28日门诊及住院1 071例PCM患者[男629例, 女442例;年龄62(29, 93)岁]骨髓形态学图文报告及相应单克隆蛋白(M蛋白)鉴定结果, 结合其中427例PCM患者Durie‐Salmon(DS)分期及国际分期系统(ISS)及436例PCM患者总生存(OS)时间, 总结相关浆细胞形态及数量特点。采用卡方检验、Kruskal-Walls检验、Spearman相关分析及Kaplan-Meier生存分析进行统计学分析。结果骨髓形态学图文报告显示573例PCM患者外周血典型形态特征包含浆细胞(40.84%)、幼稚粒细胞(30.89%)、成熟红细胞缗钱状排列(68.94%)及有核红细胞(8.55%);1 071例PCM患者骨髓浆细胞类型包括原始浆细胞372例(34.73%), 幼稚浆细胞674例(62.93%), 成熟浆细胞25例(2.34%)。骨髓浆细胞数量(占有核细胞比例)与免疫球蛋白(Ig)G和IgA型M蛋白浓度之间存在正相关(r=0.55, r=0.60, P<0.01)。1 071例PCM患者M蛋白类型占比从高到低依次为IgG(45.75%)、IgA(23.53%)、轻链型(19.61%), IgD(4.76%)、非分泌型(4.3%)、双克隆型(1.78%)、IgE型(0.19%)、IgM型(0.08%)。各种M蛋白类型相应骨髓浆细胞典型特征包括成团分布, 胞体大小不等, 胞浆内可见内容物, 胞核可见双核、多核、畸形核。原浆细胞在DSⅢ期所占比例为44.81%(164/366), 高于DSⅡ期21.57%(11/51), 差异有统计学意义(χ^(2)=10.2, P<0.05)。骨髓浆细胞数量与DS和ISS分期呈正相关(r=0.23, r=0.30, P<0.01)。骨髓浆细胞类型为原浆组OS时间较幼浆组明显缩短[56.0(23.0, 101.8)个月比75.9(31.6, 121.5)个月], HR=1.42, 95%CI 1.05~1.91, P=0.02], 骨髓浆细胞数量≥37.5%组OS时间较<37.5%组缩短[75.9(21.4, 122.6)个月比81.3(36.6, 108)个月], HR=1.54, 95%CI 1.14~2.07, P<0.05]。结论骨髓浆细胞形态及数量为PCM的诊断提供依据, 可以作为PCMObjective To investigate the value of bone marrow plasma cell morphology in the diagnosis and prognosis of plasma cell myeloma(PCM).Method Observational study.Collect the bone marrow morphology image reports and corresponding monoclonal protein(M protein)identification results of 1071 patients[629 males and 442 females,Median age 62(29,93)years]diagnosed with PCM in the outpatient and inpatient departments of Beijing Chaoyang Hospital affiliated to Capital Medical University from January 1,2017 to February 28,2022.Combined with Durie‐Salmon(DS)and International Staging System(ISS)of 427 patients diagnosed with PCM and overall survival time(OS)of 436,summarize the relevant plasma cell morphological characteristics.Statistical methods include chi-square test,Kruskal-Walls test,Spearman correlation analysis and Kaplan-Meier survival analysis.Result The bone marrow morphology reports showed that the typical morphological features of peripheral blood in 573 patients with PCM included plasma cells(40.84%),immature granulocytes(30.89%),rouleaux formation in erythrocytes(68.94%)and nucleated red blood cells(8.55%).The types of bone marrow plasma cells in 1071 patients diagnosed with PCM included 372(34.73%)plasmablasts,674(62.93%)immature plasma cells,and 25(2.34%)mature plasma cells.There is a significant positive correlation between the number of bone marrow plasma cells(proportion of nuclear cells)and the concentration of IgG and IgA type,from M protein identification(r=0.55,r=0.60,P<0.01).The proportions of M protein types in 1071 patients with PCM from high to low were IgG(45.75%),IgA(23.53%),light chain(19.61%),IgD(4.76%),non-secretory(4.3%),biclonal(1.78%),IgE(0.19%),IgM(0.08%).The typical characteristics of the bone marrow plasma cells in various M protein types included clustered distribution,different cell body sizes,inclusions in the cytoplasm,binuclear,polynuclear,and abnormal nuclear.The proportion of plasmablasts in DSⅢstage was 44.81%(164/366),higher than 21.57%(11/51)in DSⅡstage,and the difference w

关 键 词：浆细胞骨髓瘤 浆细胞 形态学 骨髓细胞学检查 

分 类 号：R733.3[医药卫生—肿瘤]