28例IgD型多发性骨髓瘤患者实验室检查特点和临床特征分析

目的探讨IgD型多发性骨髓瘤(MM)患者临床表现和实验室检查的特征。方法对28例IgD型MM患者的临床表现和实验室检查结果进行回顾性分析,同时与IgG型MM患者进行比较。结果28例IgD型MM患者中,IgD-κ亚型3例、IgD-λ亚型25例。IgD型MM患者血常规(血红蛋白、红细胞、白细胞、血小板)和血清钙与IgG型MM患者比较,差异均无统计学意义(P>0.05)。IgD型MM患者的尿素、肌酐和白蛋白均高于IgG型MM患者(P<0.05),总蛋白、IgA、IgG和IgM均低于IgG型MM患者(P<0.05)。IgD型MM患者血清总轻链、游离轻链、游离κ/λ比值及尿液总轻链、总κ/λ比值与IgG型MM比较差异均有统计学意义(P<0.05)。28例IgD型MM患者中,有21例(75%)尿液中检出本-周蛋白。IgD型MM基因型多表现为1q21扩增。结论IgD型MM临床表现缺乏特异性,需要进行全面的实验室检查,包括免疫球蛋白定量检测、免疫固定电泳、骨髓细胞形态学分析、基因检测等,以提高诊断率。

Laboratory examination results and clinical characteristics of 28 cases of IgD multiple myeloma

Objective To investigate the clinical characteristic and laboratory examination results of IgD multiple myeloma(MM).Methods The clinical manifestations and laboratory examination results of 28 patients with IgD MM were analyzed retrospectively,which were compared with those of IgG MM.Results Among the 28 cases of IgD MM,there were 3 cases of IgD-κtype and 25 cases of IgD-λtype.There was no statistical significance for blood routine test(hemoglobin,red blood cell,white blood cell and platelet)and serum calcium between IgD MM and IgG MM(P>0.05).The levels of urea,creatinine and albumin in patients with IgD MM were higher than those in patients with IgG MM(P<0.05),and the levels of total protein,IgA,IgG and IgM were lower than those in patients with IgG MM(P<0.05).There was statistical significance in total light chain,free light chain,free light chainκ/λratio and urine total light chain,urine total light chainκ/λratio between IgD MM and IgG MM(P<0.05).Among the 28 IgD MM patients,21(75%)cases were found to be Bence-Jones proteins positive in urine.The MM genotype of IgD type mostly showed 1q21 amplification.Conclusions The clinical manifestations of IgD MM are lack of specificity,which requires comprehensive laboratory examination,including the quantitative determination of immunoglobulin,immunofixation electrophoresis,morphological analysis of bone marrow cells,gene determination and so on,in order to improve the diagnosis rate.