血清唾液酸在IgA型多发性骨髓瘤诊断和治疗中的临床意义

目的 探讨血清唾液酸(SA)在IgA型多发性骨髓瘤(MM)诊断及治疗中的临床意义.方法 应用生化免疫分析仪测定50名健康体检者及76例MM患者确诊时及治疗后的血清SA水平.结果 76例MM中,IgA型25例,除IgA型外51例(IgG型40例,轻链型7例,不分泌型4例).健康对照及IgA型、IgG型、轻链型、不分泌型、除IgA型外MM患者确诊时血清SA平均水平分别为(570.33±67.72)、(1289.24±325.42)、(585.88±159.12)、(600.77±126.90)、(590.50±100.86)、(588.39±150.90)mg/L,IgA型MM患者血清SA水平高于健康对照及其他各型MM(均P<0.01),而健康对照及其他各型MM间血清SA水平差异无统计学意义(均P>0.05).IgA型MM患者确诊时血清SA水平与血清IgA、球蛋白、骨髓涂片浆细胞数、红细胞沉降率呈正相关(r值分别为0.699、0.753、0.504、0.732,均P<0.05),与血清清蛋白、IgG、血红蛋白、血小板呈负相关(r值分别为-0.712、-0.505、-0.629、-0.596,均P<0.05),与白细胞、血清肌酐、血清IgM、乳酸脱氢酶、血清钙、C反应蛋白、β2微球蛋白不相关(均P>0.05).IgA型MM患者血清SA水平随病情好转而下降,随病情加重而上升.结论 IgA型MM患者血清SA升高,是反映IgA型MM肿瘤负荷量的指标,也可作为其疗效评价的指标.     

Clinical analysis of 43 patients with light chain multiple myeloma

Objective To investigate the clinical characteristics and laboratory findings of patients with light-cham multiple myeloma. Methods Fourty-three patients with light chain myeloma over a 13-year period were analyzed retrospectively and 43 cases wish IgG type myeloma in the same period were used as control. Results Of the 43 patients, 28 were male, 15 were female, with an overall mean age of 57 years (range. 36–71). At the time of onset, the main symptoms were fatigue and dizziness (23 cases, 53.5%) and bone pain (25, 58.1%). The main signs were anemia (28, 65.1%) and bone pressure pain (23. 53.5%). Of 39 patients with determined staging, 38 were in stage III and 1 stage I. Renal function examinations were performed for 31 patients. Among them. 16 were in stage III_B and 15 in III_A. Hypercaicemia (≥3 rnmol/L) occurred in 2 cases. Of 18 patients, 3 had proteinuria ≥ 12 g per 24 hours. Osteolytic lesions appeared in 27 of 31 cases. No abnormal globulin peaks were found in the serum protein electrophoretic bands. Serum and urine immunoelectrophoresis showed that 10 cases were kappa light chain, 29 were lambda light chain and 4 were both. Nineteen patients received chemotherapy, of which 8 cases obtained complete remission and 11 had no remission. Conclusion Because of poor differentiation, skeletal destruction and renal dysfunction, light chain multiple myeloma patients have meager therapeutical efficacy and poor prognosis.     

Clinical Analysis of 43 Patients with Ught Chain Multiple Myeloma

OBJECTIVE To investigate the clinical characteristics and laboratory findings of patients with light-chain multiple myeloma. METHODS Fourty-three patients with light chain myeloma over a 13year period were analyzed retrospectively and 43 cases with IgG type myeloma in the same period were used as control. RESULTS Of the 43 patients, 28 were male, 15 were female, with an overall mean age of 57 years (range, 36-71). At the time of onset, the main symptoms were fatigue and dizziness (23 cases, 53.5%) and bone pain (25, 58.1%). The main signs were anemia (28, 65.1%) and bone pressure pain (23, 53.5%). Of 39 patients with determined staging, 38 were in stage Ⅲ and 1 stage Ⅰ. Renal function examinations were performed for 31 patients. Among them, 16 were in stage ⅢB and 15 in ⅡA. Hypercalcemia (≥3 mmol/L) occurred in 2 cases. Of 18 patients, 3 had proteinuria ≥12 g per 24 hours. Osteolytic lesions appeared in 27 of 31 cases. No abnormal globulin peaks were found in the serum protein electrophoretic bands. Serum and urine immunoelectrophoresis showed that 10 cases were kappa light chain, 29 were lambda light chain and 4 were both. Nineteen patients received chemotherapy, of which 8 cases obtained complete remission and 11 had no remission. CONCLUSION Because of poor differentiation, skeletal destruction and renal dysfunction, light chain multiple myeloma patients have meager therapeutical efficacy and poor prognosis.     

The clinical spectrum of pure Bence Jones proteinuria. A study of 66 patients

Sixty-six consecutive patients exhibiting isolated urinary excretion of monoclonal free light chains, i.e. Bence Jones protein (BJP), on screening investigation for serum and urine monoclonal immunoglobulins were studied in order to better define the spectrum of immunoproliferative disorders associated with such a protein abnormality. The typical plasma cell neoplasms accounted for only one third of the cases, multiple myeloma (MM) and systemic amyloidosis (AL) being diagnosed in 18% and 15% of the patients, respectively. Eighteen (27%) of the patients were recognized as having malignant nonHodgkin's lymphomas (NHL), 21 (32%) had chronic lymphocytic leukemia (CLL), and 2 (3%) had hairy cell leukemia (HCL). Three patients (5%) without apparent evidence of any malignant immunoproliferative disease were classified as having a monoclonal gammopathy of undetermined significance (MGUS). The greatest urinary concentrations of BJP were found in plasmacytic neoplasms, the daily excretion of MM patients being significantly higher than that of AL patients. Considerably lower BJP outputs were recorded in the other diseases, the lowest ones being associated with MGUS. NHL patients had a daily excretion four times higher as compared with that of CLL patients. The distribution of NHL by histologic type was: follicular center cell lymphomas (FCCL) 39%, small lymphocytic lymphoma (SLL) 33%, immunoblastic lymphoma (IBL) 17%, and plasmacytoid lymphocytic lymphoma (PLL) 11%. The highest BJP levels were found in PLL, and the lowest ones in FCCL. In CLL patients the amount of urinary BJP correlated significantly with the tumor load, as estimated by the number of enlarged lymphoid areas. The study suggests that detection and measurement of isolated urinary BJP may provide useful data for the clinical evaluation of a wide spectrum of immunoproliferative disorders.     

多发性骨髓瘤患者血清胆固醇水平的临床意义

 目的　探讨多发性骨髓瘤（MM）患者血清胆固醇水平变化及其与分型、分期的关系。方法　回顾分析65例MM患者诊断时血脂水平,包括总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1（Apo-A1）和载脂蛋白B（Apo-B）,探讨血脂参数与MM患者免疫球蛋白类型和临床分期关系。以健康体检者30例作为对照组。结果　65例MM患者中IgG型35例（53.85 %）,Ⅲ期41例（63.1 %）,MM患者血清TC、HDL-C、 LDL-C、Apo-A1和Apo-B明显低于对照组 （P＜0.05）,两组TG差异无统计学意义（P＞0.05）;除1例IgD型外,其余64例患者中,IgG和IgA型患者血清TC、HDL-C、LDL-C、Apo-A1和Apo-B均显著低于轻链型（P＜0.05）,TG水平在不同Ig类型患者间无差别;Ⅲ期患者血清TC、HDL-C、LDL-C和Apo-A1均显著低于Ⅰ期患者和对照组（P均＜0.05）,且Ⅱ期患者血清LDL-C 也显著低于Ⅰ期患者（P＜0.05）。结论　MM患者存在低胆固醇血症,且血清胆固醇水平与疾病分期有关。     

Special IgD-λ type multiple myeloma based on bone marrow cell morphology: A case report

We aimed to explore the changes of laboratory indexes of IgD-λ type multiple myeloma with special cell morphology, and to improve the cognition of IgD-λ type MM. To explore the changes of laboratory indexes of IgD-λ type 1 multiple myeloma with special cell morphology, and to improve the cognition of IgD-λ type MM. The morphology of bone marrow cells, immunofixation electrophoresis, serum free light chain (sFLC) and other detection indexes of a patient with IgD-λ type MM treated in Handan Central Hospital in December 2020 were analyzed. The patient bone marrow smears showed 62％ of abnormal cells–which were distributed in clusters and resembled lymphoma and metastatic cancer cells. The Flowcytometry indicates that the cell is a plasma cell tumor.Immunoglobulin IgG, IgA and IgM were all lower than the normal range.There is a monoclonal light chain λ component in immunofixation electrophoresis.The serum free light chain λ was 2700.00 mg/ L, light chain k/λ is 0.0023, the high of serum calcium, LDH, β2 microglobulin. IgD-λ type MM is a rare type of MM. The age of onset is young, the invasiveness is strong, the prognosis is poor, the clinical manifestation is complex, and it is easy to be misdiagnosed or missed. The analysis of the clinical symptoms and laboratory characteristics of the disease plays a positive role inthe diagnosis, treatment and prognosis of the disease .     

多发性骨髓瘤相关肾损害的危险因素

目的:分析多发性骨髓瘤相关肾损害的危险因素。方法:回顾性分析2009年1月-2013年12月我院收治的多发性骨髓瘤89例患者资料。将患者分为A组（肾功能正常）57例,B组（肾功能损害）32例,各因素首先采取单因素分析,对具有统计学意义的因素进一步采取非条件多因素Logistic回归分析。结果:单因素分析显示,两组患者Hgb、血Ca、血P、血URIC、血清β2-MG、尿本周氏蛋白、轻链类型、感染以及肾毒性药物九个因素比较,差异具有统计学意义（P＜0.05）。对上述单因素具有统计学意义的八个因素进行多因素Logistic回归分析,血Ca、轻链类型以及Hgb三个因素进入回归模型（P＜0.05）。结论:肾损害是多发性骨髓瘤患者的主要表现,高血钙、单克隆免疫球蛋白游离轻链类型以及贫血是多发性骨髓瘤患者发生相关性肾损害的独立危险因素。     

多发性骨髓瘤常用实验诊断方法评价

目的：比较血清蛋白电泳（琼脂糖凝胶法）、尿本周氏蛋白、骨髓细胞学等实验室指标对多发性骨髓瘤的诊断价值，找出经济、简便、快速的敏感指标。方法：分析多发性骨髓瘤的诊断过程，计算血清蛋白电泳、尿本周氏蛋白、骨髓细胞学诊断的敏感度和特异度。结果：琼脂糖凝胶血清蛋白电泳的敏感度是96．6％，特异度96．4％；尿本周氏蛋白的敏感度是10．5％，特异度98．2％；骨髓细胞学的敏感度是51．7％，特异度100％。结论：琼脂糖凝胶血清蛋白电泳的敏感度最高，且简便、快速、经济实用。     

IgG-2κ轻链型多发性骨髓瘤三例临床和实验室特征

目的 探讨IgG-2κ轻链型多发性骨髓瘤(MM)的临床和实验室特征.方法 结合相关文献分析3例IgG-2κ轻链型MM患者的临床资料和实验室结果 .结果3例患者中,男性2例,女性1例,年龄50~82岁,主要表现为腰痛、感染、贫血和肾功能损害,X线和(或)磁共振成像检查均显示多发溶骨性骨质破坏.血清IgG正常、轻度或明显升高,IgA和IgM均降低.血清和尿液κ轻链均明显升高,尿本周蛋白均阳性.2例患者血清蛋白电泳可见γ区形成双M蛋白峰.血清免疫固定电泳可见抗IgG单条带和抗κ轻链双条带.骨髓涂片可见异常浆细胞明显增多.2例患者分别接受DVD、VAD方案化疗达部分缓解和疾病稳定,1例患者因肺部感染、急性左心衰竭、急性肾衰竭放弃治疗.结论 IgG-2κ轻链型MM临床表现缺乏特征性,但某些实验室特点可能不同于IgG-κ轻链型,是否属于双克隆型MM有待研究证实.     

Monoclonal immunoglobulin light chain in urine of patients with B lymphocytic disease: its source and use as a diagnostic aid

The presence of tumour-related monoclonal light chain has been sought in urine as an immunochemical aid in the diagnosis of B lymphocytic neoplasms. The technique of isoelectric focusing in agarose followed by immunofixation has been applied to concentrated urines from 41 patients. In chronic lymphocytic leukaemia involving neoplastic B lymphocytes, monoclonal light chain was detected in 14 out of 19 patients investigated. For 2 of the positive cases (one kappa light chain type and one lambda light chain type) the urinary light chains were compared directly with culture fluids obtained after incubation of the corresponding neoplastic cells obtained from the patient's peripheral blood: identity of the light chains from urine and cells was established by isoelectric focusing demonstrating for both patients that the tumour cells were the source of the urinary light chain. In patients with non-Hodgkin's lymphoma involving neoplastic B lymphocytes, urinary monoclonal light chains were found in 7/16 of those studied. Such light chains were not detected in 11 control subjects, in 3 patients with true histiocytic tumours or in 2 patients with enlarged reactive lymph nodes. The technique is simple to perform and provides information for diagnosis and possibly monitoring of B cell neoplasms.     

多发性骨髓瘤患者M蛋白标记的临床意义

目的:探讨多发性骨髓瘤（multiple myeloma,MM）患者血清蛋白电泳M蛋白标记的临床意义,观察其定量水平监测疾病进展和评估治疗药物的疗效。方法:对169例患者血清蛋白电泳的M蛋白波峰进行柱状法标记,通过免疫固定电泳(IFE)确诊其免疫分型,同时进行血清总蛋白（TP）、白蛋白(ALB)含量检测。连续追踪25例初诊诊断为MM患者的血清蛋白电泳,将M蛋白波峰标记得到M 蛋白百分比,换算M 蛋白浓度。换算公式:M 蛋白浓度（g/L）=TP浓度（g/L）×M蛋白百分比（%）,将计算结果进行对比。结果:在169例患者中,血清蛋白电泳β区见M蛋白波峰49例（29.0%）、γ区见M蛋白波峰120例（71.0%）,经过IFE分型:κ型IgG 型48例(28.4%),λ型IgG型43例(25.4%);κ型IgA型14例(8.3%),λ型IgA型16例(9.5%);κ型IgM 11例(6.5%),λ型IgM 3例(1.8%);κ型IgD型 2例(1.2%),λ型IgD型6例(3.6%); 游离κ轻链型2例(1.2%),游离λ轻链型8例(4.7%);双克隆型 1例(0.6%);未见单克隆条带15例(8.9%)。随访和监测25例MM患者化疗疗效评估:化疗后较化疗前白蛋白明显升高;其中β区M蛋白4例,β球蛋白及M蛋白浓度明显降低,差异均有统计学意义（P＜0.05）;γ区M蛋白21例,γ球蛋白及M蛋白显著降低（P＜0.05、P＜0.01）,其中M蛋白持续存在的MM患者,第1次评估血清TP含量和M 蛋白浓度明显下降、ALB含量明显升高,第2次评估TP、ALB含量在正常参考值区间,趋于平稳,M 蛋白浓度逐渐下降,可至消失。结论:血清蛋白电泳M蛋白的标记是诊断MM、巨球蛋白血症、淀粉样变等浆细胞病的依据,可作为标志物对其定量,更好的为监测疾病进展和评估治疗药物的疗效提供指导。     

Low Grade Fibromyxoid Sarcomas and Multiple Myeloma in the Same Patient: One Case Report and Literature Review

Introduction Multiple myeloma (MM) is a neoplastic plasma cell dyscrasia char-acterized by anemia; a monoclonal protein(M-protein) in the serum and/or urine; abnormal bone radiographs and bone pain;hypercal-cemia; and renal insuf.ciency or failure.According to the results of immunoelectrophoresis, patients are separated to Ig type (IgG, IgA, IgD, IgE and IgM); light chain; nonsecretory[1].     

The Value of the Bone Marrow Plasma Cell Cytoplasmic Light Chain Ratio in Differentiating Between Multiple Myeloma and Monoclonal Gammopathy of Undetermined Significance

We compared the plasma cell light chain ratios in the bone marrows of 13 patients with multiple myeloma (MM), with those of 13 patients with monoclonal gammopathy of undetermined significance (MGUS). The mean light chain ratio in favour of the paraprotein isotype in the myeloma group was 51.83 (95% confidence limits (CL) 29.52-74.14) while in the MGUS group it was 5.30 (CL 2.07-8.52). The difference between the MGUS and MM groups was significant (p = 0.0005). Neither the bone marrow plasma cell count nor the paraprotein level were significantly correlated with the light chain ratio in either of these two groups. We found a cut-off ratio of 8 to be the most useful in differentiating between myeloma and MGUS. Only one patient with myeloma had a ratio below 8, and one MGUS patient had a ratio above this cut-off point. We conclude that determination of the bone marrow plasma cell light chain ratio is a simple and useful test in differentiating between myeloma and MGUS in difficult cases.     

双克隆型多发性骨髓瘤3例并文献复习

目的:探讨双克隆型多发性骨髓瘤(multiple myeloma,MM)的临床特征.方法:分析我院诊断的3例双克隆型MM,并进行文献复习.结果:病例1患者抗SSA强阳性(++),SSB(+),抗Ro-52强阳性(++),被诊断为IgG-KAP并IgA-LAM型MM合并干燥综合征.经VAD方案化疗后IgG-KAP型M蛋白消失,出院后给以TCD方案维持治疗,目前病情平稳.病例2患者被诊断为IgG-KAP并游离KAP型MM,给予VAD方案化疗后IgG降至正常水平,出院后给以TCD方案维持治疗,目前病情平稳;病例3患者诊断为IgG-KAP并IgA-KAP型MM,合并肾功能不全及高钙血症,给予TCD方案并结合透析治疗,1个月后死于肾功能衰竭;结论:双克隆型MM罕见,临床表现多样,预后可能较差,尚需更多的病例以总结其临床特征.     

Analysis of serum free light chains by crossed immunoelectrophoresis: comparison with urinary light chains in light chain disease

We investigated the relationship between serum free light chain levels measured by crossed immunoelectrophoresis in ten patients with light chain disease and traditional 24-hour urinary light chains in the same patients. The crossed immunoelectrophoresis test requires only a venipuncture for specimen acquisition, can be completed within 24 hours, and has a reproducibility (+/- 14%) comparable with that of other immunoprecipitin techniques. Twenty-eight serum-urine pairs, representing 18 discrete intervals, were analyzed. There was a close relationship between changes in serum and urine light chain levels, with a correlation coefficient of .77 or .93, depending on the method of calculation. This suggests that serum light chain levels measured by crossed immunoelectrophoresis would be equivalent to urinary light chain levels as indicators of tumor burden. Monitoring serum levels would have the advantage of greatly simplified specimen acquisition. In patients with renal failure, serum light chain levels should be a superior indicator of light chain synthesis.     

Expression of p21<Superscript>waf1/cip1</Superscript>, p27<Superscript>kip1</Superscript>, p63 and Androgen Receptor in Low and High Gleason Score Prostate Cancer

The aim of this study was to investigate the expression of p21^waf1/cip1, p27^kip1, p63 and androgen receptor proteins in relation to serum prostate specific antigen levels in low and high Gleason score prostate cancers. Biopsies of patients suffering from prostate adenocarcinoma of low (3 + 3 to 3 + 4) and high (5 + 4 to 5 + 5) Gleason scores (13 cases each group) were immunostained for positive regulators of cell cycle control (p21^waf1/cip1 and p27^kip1), and essential markers of normal prostate gland ontogeny (p63) and growth (androgen receptor) to find differentially expressed markers of malignant progression. Serum prostate specific antigen levels were also monitored at the time of biopsy and following anti-androgen therapy. All cases except one in each group were androgen receptor positive. P63 and p21^waf1/cip1 proteins detected in normal basal cell nuclei were lost in all but one studied tumors respectively. P27^kip1 protein, however, was detected in all low Gleason score prostate cancers, but it was found in only 7/13 high score cases. Prostate specific antigen levels, either pre- or post-treatment, did not show strict correlation with the p27^kip1 results. The low to high grade dedifferentiation of prostate adenocarcinoma is accompanied with the down-regulation of p27^kip1 protein, which may be an important molecular sign of the lost cell cycle control.     

A survey of prognostic value of serum factors in multiple myeloma patients before treatment: macrophage-colony stimulating factor (M-CSF) is a powerful predictor of survival

Cytokines are involved in the pathogenesis of multiple myeloma (MM) and other cancers. The aim of this study was to evaluate a range of cytokines of diverse activity in patients with multiple myeloma for a possible prognostic value. Concentrations of the following cytokines and cytokine receptors were measured by ELISA in the sera of 64 untreated MM patients: IL-6, IL-8, IL-10, TNFα, sTNF R I and II, sIL-2Rα, IL-1ra, M-CSF, G-CSF, VEGF, and bFGF. Serum levels of sTNF RI, IL-6, and bFGF were elevated in over 50% of patients. There was an inverse relationship between sTNF RII, TNFα, IL-1ra, and albumin levels. There was no significant relationship between cytokines/cytokine receptors and other serum correlates of myeloma. In a univariate survival analysis, β2-microglobulin, LDH, sIL-2Rα, sTNF RI, and M-CSF were significant variables. In a multivariate analysis, only M-CSF and β2-microglobulin retained a significant influence on survival. Serum M-CSF may be considered another independent and clinically useful prognostic factor in multiple myeloma.     

Studies on the Mechanism of Hypoproteinemia in Gastric Cancer: 1. Albumin Leakage into the Stomach in Gastric Cancer Patients

The leakage of serum albumin into the gastric juice was measuredusing ¹³¹I-RISA as a tracer in 30 cases with — and eightcases without — gastric carcinoma. A marked increase ofalbumin leakage was noticed in six cases with gastric cancer.Apparent correlation was not found between the degree of leakageof serum albumin and any such factors as age, sex, gastric acidity,PAS stainability, Borrmann's type, histological type and sizeof crater. Edema of mucosa and submucosal tissue and severe lymphatic invasionof cancer cells were found in the cases with high leakage. Thesefindings, therefore, suggested that stasis of lymph in the tumorand the surrounding normal tissue of the stomach was one ofthe causes of albumin leakage into the lumen of the stomach. ^*This work was supported by a grant from the Ministry of Healthand Welfare.     

Low circulating adiponectin and resistin, but not leptin, levels are associated with multiple myeloma risk: a case–control study

Accumulating evidence supports a role for obesity in the etiology of multiple myeloma (MM). The distinct possibility exists that obesity may be linked to MM through altered adipokine secretion and circulating levels, one of which, adiponectin, has a protective role in several malignancies, including leukemia. In this case–control study, we investigated the role of serum adiponectin, resistin, and leptin levels in the etiopathogenesis of MM and we explored their association with several established prognostic factors. Seventy three patients with incident, histologically confirmed MM and 73 controls matched on gender and age were studied between 2001 and 2007, and blood samples were collected. Serum adiponectin, leptin, resistin, as well as MM prognostic parameters were determined. Statistical analysis of the data was performed using univariate and multivariate analyses. Lower serum adiponectin and resistin levels were associated with higher risk of MM by bivariate analysis and after adjusting for age, gender, BMI, and serum levels of leptin (p < 0.0001). Adiponectin may have a protective role in MM, whereas leptin was not associated with risk for MM at a comparable level of significance and resistin levels may be decreased via a compensatory mechanism. Further studies are needed to confirm these associations and to explore the mechanisms underlying adiponectin’s role in MM and plasma cell dyscrasias.