以多浆膜腔积液为首发症状的IgD型多发性骨髓瘤的临床研究  

Clinical study of IgD type multiple myeloma with multiple plasmacytoma as the first symptom

作　　者：张楠[1] 郝云静 刘翠清[1] 王金伟 刘成 杜士卜[1] 刘东梅[1] 李静[2] ZHANG Nan;HAO Yunjing;LIU Cuiqing;WANG Jinwei;LIU Cheng;DU Shibo;LIU Dongmei;LI Jing(Department of Laboratory Medicine,Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang,Hebei 050000,China;Department of Hematology,Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang,Hebei 050000,China)

机构地区：[1]河北省中医院检验科,河北石家庄050000 [2]河北省中医院血液科,河北石家庄050000

出　　处：《检验医学与临床》2024年第16期2442-2444,2448,共4页Laboratory Medicine and Clinic

基　　金：河北省中医药管理局科研计划项目(2022053)。

摘　　要：目的 探讨多发性骨髓瘤(MM)浆膜腔浸润的机制,并探讨浆膜腔积液在MM诊断、治疗中的意义和浆膜腔积液细胞形态学的诊断价值。方法 分析该院收治的1例以多浆膜腔积液为首发症状的IgD型MM患者从入院到诊断过程;同时以“浆膜腔积液”“多发性骨髓瘤”为关键词,对中国知网和万方数据库2020年1月至2023年12月发表的文献进行文献检索。结果 首先从该例患者浆膜腔积液细胞形态学检查发现大量异常浆细胞,进一步确诊为MM(IgDλ型);文献检索结果:共检索到中文文献15篇,英文文献3篇,排除重复文献,最终保留中文文献7篇,英文文献2篇。结合病例和文献复习发现,以多浆膜腔积液为首发症状的MM是一种极为罕见的表现,而且骨髓瘤细胞浸润浆膜腔后通常会发生形态变异,容易误诊、漏诊。结论 对多浆膜腔积液患者应及时行浆膜腔积液检查,明确浆膜腔积液的良、恶性,以降低MM等恶性疾病的误诊率、漏诊率。Objective To explore the mechanism of serous cavity effusion in multiple myeloma(MM)and to explore the significance of serous cavity effusion in the diagnosis and treatment of MM,as well as the diagnostic value of serous cavity effusion cell morphology.Methods The entire process from admission to diagnosis of an IgD type MM patient with multiple serosal cavity effusion as the initial symptom was analyzed.A literatures search was conducted on literatures published on China National Knowledge Infrastructure and Wanfang Database from January 2020 to December 2023,using"serous fluid accumulation"and"multiple myeloma"as keywords.Results In this study,the patient was first discovered a large number of abnormal plasma cells from the morphology of the serous cavity effusion cells,and further diagnosed with MM(IgDλtype).Literature search results showed that a total of 15 Chinese literatures and 3 English literatures were retrieved,excluding duplicate literature,7 Chinese literatures and 2 English literatures were retained finally.The ananlysis of the case in this study and review literatures revealed that MM with multiple plasma lumen effusions as the first symptom was an extremely rare presentation,and myeloma cells infiltrating the plasma lumen usually underwent morphologic variability,making it easy to misdiagnose and underdiagnose MM.Conclusion For patients with multiple serous cavity effusion,timely serous cavity effusion examination should be performed if conditions permit,to clarify the benign and malignant aspects of serous cavity effusion to reduce the misdiagnosis rate and missed diagnosis rate of malignant diseases such as MM.

关 键 词：多发性骨髓瘤 骨髓瘤性积液 多浆膜腔积液 糖类抗原125 

分 类 号：R733.3[医药卫生—肿瘤] R446.1[医药卫生—临床医学]