IgD型多发性骨髓瘤患者实验室检查结果分析

目的 IgD型多发性骨髓瘤患者临床上较为少见,通过实验室检查,以求发现其特点,避免漏诊。方法分别收集20例本实验室检测到的IgD型I、gG型I、gA型I、gM型多发性骨髓瘤患者的实验室检查结果,分析IgD型与其它较为常见类型的多发性骨髓瘤患者实验室检查结果的异同。结果 IgD型多发性骨髓瘤患者的免疫球蛋白定量结果显示,IgGI、gA和IgM含量均减低者有18例占90%,其余两例3种免疫球蛋白含量处于正常下限。轻链定量发现,20例IgD型多发性骨髓瘤患者有19例为IgD型λ轻链型,占95%,而IgD型κ轻链型仅1例,且20例中有19例是轻链比值异常的。IgD型多发性骨髓瘤患者的血清蛋白电泳阳性率与其余类型无显著差异（P〉0.05）;免疫固定电泳显示IgD泳道有特异性的抗原抗体沉淀带。结论如实验室检查发现患者免疫球蛋白IgGI、gA和IgM含量均减低、轻链比值异常、血清蛋白电泳出现阳性条带,要高度怀疑其为IgD型多发性骨髓瘤,免疫固定电泳时务必加IgD泳道,以避免IgD型多发性骨髓瘤的漏诊。

Analysis of the laboratory results of IgD type multiple myeloma

Objective To analyze the results of immunoglobulin,serum protein electrophoresis（SPE） and immunofixtion electrophoresis（IFE） in the laboratory diagnosis of IgD type multiple myeloma（MM） patients.Methods 20 cases of IgD、IgG、IgA、IgM type multiple myeloma were collected.All patients were analysed by serum protein electrophoresis and immunofixation electrophoresis,and quantified by rate nephelometric method for IgG、IgA、IgM、kappa and lambda.Results Among the 20 cases of IgD type MM,IgD-κ type MM were 1,lgD-λ type MM were 19.The immunoglobunin IgG、IgA、IgM were decreased in 19 cases of IgD type MM.And no significant difference was found in the positive rates of M protein between IgD type MM and others by serum protein electrophoresis.Conclusion If the laboratory results show that immunoglobulin decreased、the ratio of κ/λ abnormal and M protein positive,IgD type multiple myeloma must be highly suspected.And to avoid the miss diagnosis of IgD type MM,IgD antibody must be added while IFE was running.