多发性骨髓瘤实验室结果分析与评价

目的分析多发性骨髓瘤（MM）实验室检查结果,评价相关实验室指标。方法回顾性分析我院2007～2010年收治的52例MM患者实验室检查资料。结果52例MM中,45例表现不同程度贫血,51例血沉明显增快,蛋白尿31例,尿本周蛋白阳性11例;血清蛋白电泳4J6例1区带见单克隆峰,24例行免疫固定电泳,其中IgG—K型7例,IgG-λ型6例,IgA—K型4例,IgA-λ型3例,IgM-λ型2例,轻链λ1例,正常1例;TP〉80g／L28例,GLO〉30g／L36例,白球比A/C〈1．039例,血清钙〉2．7mmol／L12例;骨髓涂片瘤细胞比例4．5％-76．5％（平均40．5％）。结论MM实验室检查结果复杂多变,综合分析各项实验室指标,有利于提高MM诊断的准确性。     

多发性骨髓瘤的影像诊断

多发性骨髓瘤是恶性浆细胞疾病中最常见的一种类型，是单克隆浆细胞异常增生所致的一种恶性肿瘤，发病率约占血液系统肿瘤的10％，多见于中老年人，平均发病年龄68岁，男性多于女性。近年来发病率有增多趋势，并且发病年龄提前。本病起病缓慢，早期多无症状，临床表现复杂，早期诊断困难，漏、误诊断率高。我们搜集2002年1月至2007年12月底资料完整并经过骨髓穿刺证实的骨髓瘤20例，分析其X线和CT表现特点，以提高对本病的认识。     

多发性骨髓瘤患者外周血IL—4产生细胞的检测及其意义

本应用碱性磷酸酶抗碱性磷酸酶（ＡＰＡＡＰ）法检测了９例多发性骨髓瘤（ＭＭ）患和１１例健康人外周血ＩＬ－４产生细胞。结果表明：ＭＭ患外周血ＩＬ－４产生细胞（７．６％±２．１％）显少于正常人（１５．３６％±４．１％），（Ｐ＜０．００１），并与患外周血免疫球蛋白水平的减少呈显相关。提示ＩＬ－４产生细胞减少与ＭＭ患免疫球蛋白的分泌抑制有关。     

多发性骨髓瘤的治疗现状

多发性骨髓瘤(Multiple myeloma,MM)是一种起源于B淋巴细胞的浆细胞异常增生的恶性肿瘤,该浆细胞可产生单克隆免疫球蛋白和(或)其轻链,正常的多株免疫球蛋白合成受抑.骨髓瘤细胞在骨髓内克隆性增殖,主要表现为:骨骼疼痛;反复感染;肾脏疾病;神经病变;出血和血栓形成;高钙血症等.     

多发性骨髓瘤的临床及全身磁共振分析

目的:分析多发性骨髓瘤的临床特征及其全身磁共振表现,探讨全身磁共振分期与临床分期之间的关系。方法:采用Siemens 3.0T磁共振对15例经病理证实的多发性骨髓瘤患者进行全身检查。采用Fisher精确概率法对磁共振及临床两种分期方法进行分析。结果:多发性骨髓瘤最常见的临床表现有骨痛、贫血、乏力、肝脾肿大和浅表淋巴结肿大等;15例患者中全身磁共振表现为正常型4例,弥漫型3例,局灶型3例,混合型4例,胡椒面型1例。磁共振分期为Ⅰ期4例,Ⅱ期3例,Ⅲ期8例,临床分期为Ⅰ期1例,Ⅱ期4例,Ⅲ期10例。两种分期方法进行统计学分析得出P=0.46>0.05。结论:多发性骨髓瘤临床表现多样化,主要表现为骨痛;全身磁共振成像对于多发性骨髓瘤具有较好的成像效果和评估价值;两种分期方法之间没有统计学差异。     

多发性骨髓瘤的临床及X线分析

目的：提高对多发性骨髓瘤的认识和诊断水平，探讨其X线表现。方法：对15例经检查骨髓证实的病例，结合献，回顾分析其临床及X线表现。结果：多发性骨髓瘤主要征象为，①多发性骨破坏，呈圆形或类圆形透亮区，大小不等．可有软组织包块，多发生于扁骨及长骨近端。②病理骨折多发生于肋骨，长骨近端病变亦可发生病理骨折：③骨质疏松，多为周身性普遍性骨质疏松，表现为骨密度减低，骨皮质变薄，骨小梁纤细、模糊不清，可与多发骨破坏同时存在。此外，8例胸片发现肋骨破坏，余7例亦经X线检查发现不同程度的骨破坏经骨髓及周围血像中找到分化不好的浆细胞而确诊，其中7例本-周氏蛋白阳性。结论：多发性骨髓瘤X线检查具有重要意义，只要认真分析X线征象，密切结合临床及实验室检查、是能够及时准确做出诊断的，对一些不典型病例应提示临床多体位拍片，做一系列临床实验室检查，以排除骨髓瘤的可能性。     

多发性骨髓瘤发病率的宏观状况与诊断率提高问题

多发性骨髓瘤发病率的宏观状况与诊断率提高问题尚克中多发性骨髓瘤（骨髓瘤），为一复杂而特殊的恶性骨肿瘤，其发病率较其他全部恶性骨肿瘤的总和还多，在肿瘤统计中常将其列为“多发性骨髓瘤和免疫增生性肿瘤”而不计入原发恶性骨肿瘤。笔者对近年来国内外发表的有关骨...     

IL-1对多发性骨髓瘤细胞粘附分子表达的影响

为探讨人骨髓瘤细胞株ＫＭ３表面粘附分子的表达及ＩＬ－１对粘附分子表达的影响，应用直接免疫荧光标记流式细胞术分析人骨髓瘤细胞株ＫＭ３细胞表面粘附分子表达，以荧光阳性率和平均荧光强度两个指标反映粘附分子的表达量，研究ＩＬ－１对ＫＭ３细胞粘附分子表达调控。发现正常情况下，ＫＭ３细胞表面表达粘附分子ＣＤ４４、ＣＤ５４、ＣＤ４９ｂ、ＣＤ４９ｅ、ＣＤ４９ｆ，不表达ＣＤ５６和ＣＤ４９ｄ；ＩＬ－１以剂量非依赖方式促进ＫＭ３细胞表面ＣＤ４４、ＣＤ５４、ＣＤ４９ｂ、ＣＤ４９ｅ、ＣＤ４９ｆ表达。为进一步应用ＫＭ３细胞探讨粘附分子在ＭＭ发病机制中的作用提供实验依据     

多发性骨髓瘤循环miRNAs的研究进展及应用

多发性骨髓瘤(Multiple Myeloma,MM)是一种多发于中老年人群的恶性浆细胞肿瘤.近年来,随着新药的开发及造血干细胞移植的广泛应用,MM患者的生存时间明显延长,但仍旧不能治愈,几乎所有患者均会复发、难治、甚至不治.在MM发生发展以及治疗过程中,精准的预后分层、及时准确的疗效评估对临床诊治有着重要意义.MM细...     

白介素-6对马法兰诱导多发性骨髓瘤细胞KM3凋亡的影响

目的探讨白介素-6（IL-6）在马法兰诱导人多发性骨髓瘤细胞株KM。凋亡效应中的作用及其可能的分子机制。方法运用流式细胞仪技术（FACS）、DNA片段化百分率、凋亡细胞的原位检测（TUNEL法）和Western blot分析，观察II；6对马法兰诱导KM。细胞凋亡的影响及其caspase-3、caspase-8蛋白表达的变化。结果IL-6作用可使马法兰诱导的KM3细胞凋亡减少，同时caspase-3蛋白表达降低。结论1176可通过调节caspase-3、caspase-8表达保护马法兰诱导的KM3细胞凋亡。     

Effect of Systemic Therapies on Outcomes following Vertebroplasty among Patients with Multiple Myeloma

BACKGROUND AND PURPOSE:The role of vertebroplasty in patients with myeloma remains relatively undefined. Accordingly, we sought to better define the efficacy of vertebroplasty for myeloma-associated fractures and determine the effect of procedure timing relative to the initiation of systemic therapy on outcomes and complication rates.MATERIALS AND METHODS:Clinical, laboratory, and medication data were retrieved for 172 patients with multiple myeloma treated with vertebroplasty since October 2000. Quantitative outcome data (Roland-Morris Disability Questionnaire [scale, 0–24] and the Numeric Rating Scale [0–10] for pain at rest and with activity) were collected immediately pre- and postoperatively and at 1 week, 1 month, 6 months, and 1 year following vertebroplasty. Patients with ≥50% improvement on the Numeric Rating Scale and ≥40% improvement on the Roland-Morris Disability Questionnaire were classified as “responders.” Peri- and postoperative complications were also collected.RESULTS:Significant median improvement in the Roland-Morris Disability and rest and activity Numeric Rating Scale scores (15, 2, and 6 points, respectively; P < .0001) persisted at 1 year without significant change from the immediate postoperative scores (P > .36). Patients on systemic therapy at the time of vertebroplasty were more likely to achieve “responder status,” compared with patients not on systemic therapy, for the Numeric Rating Scale pain at rest score (P < .01) and the Roland-Morris Disability Questionnaire score (P < .003), with no difference in complication rates (χ² = 0.17, P = .68).CONCLUSIONS:Vertebroplasty is an effective therapy for patients with myeloma with symptomatic compression fractures. Favorable outcomes are more likely to be achieved when spinal augmentation is performed after systemic therapy is initiated. Complication rates were not affected by the timing of systemic therapy.

For the past 20 years, vertebroplasty has been shown to be an effective treatment for symptomatic vertebral compression fractures refractory to medical therapy.^1,2 Although recent evidence suggests that the pain reduction derived from this procedure may not be attributable to the injection of the cement itself, the data are clear that vertebroplasty recipients experience durable improvement in mobility and reduced narcotic use that persist for months to years following therapy.³ Although patients with osteoporosis comprise most vertebroplasty recipients in the United States, traumatic and pathologic fractures have also been treated with percutaneous spinal augmentation.^4–6 Among pathologic fracture etiologies, multiple myeloma is one of the more common indications for intervention. Patients with myeloma are particularly prone to pathologic vertebral compression fractures due to systemic osteoporosis from cytokine-mediated imbalance of osteoclast and osteoblast function and systemic corticosteroid therapy.⁶Although a large body of evidence exists demonstrating the efficacy of vertebroplasty among patients with benign osteoporotic vertebral compression fractures, the data in support of its use in the treatment of pathologic fractures among patients with multiple myeloma remain limited. In part, data from patients with myeloma are limited due to their reduced survival time, clinical uncertainty with respect to improvement in pain in the setting of diffuse disease, uncertainty as to when to treat, and a higher threshold of treatment criteria for patients with diffuse disease. In contradistinction to patients with benign compression fractures, patients with myeloma are often on multidrug systemic therapy and may have hematologic derangements related to their disease and/or treatment. These factors may confound outcomes and potentially render patients with myeloma more predisposed to adverse events.The purpose of this study was to better define the efficacy of vertebroplasty for myeloma-associated fractures and determine the effect of procedure timing relative to the initiation of systemic chemotherapy and the extent of disease on outcomes and complication rates.     

多发骨髓瘤的临床与X线诊断

目的　总结 16例多发骨髓瘤的临床表现与X线诊断。方法　回顾性分析 16例具有完整临床资料的多发骨髓瘤的X线改变。所有病例均经骨髓穿刺确诊。结果　X线主要征象有 :骨质无明显改变者 3例 ;骨质疏松 8例 ;骨质破坏 12例 ;骨质硬化 1例 ;软组织肿块 6例。结论　多发骨髓瘤的诊断主要依靠临床及X线表现。骨髓穿刺检查对本病具有决定诊断的价值 ,并应进行必要的鉴别诊断     

多发性骨髓瘤的18F-FDG PET/CT鉴别诊断及疗效评估价值

目的:分析多发性骨髓瘤(M M)的18F-FDG PET/CT影像表现,探讨PET/CT对MM的鉴别诊断及疗效评估价值.方法:回顾性分析近3年来我院经病理证实的22例M M患者的PET/CT影像资料,包括男13例,女9例.其中5例有治疗后多次PET/CT随访影像资料.结果:22例均为多发骨病灶,合并病理骨折11例38处病灶.PET/CT表现为弥漫性或多发穿凿样骨破坏,骨破坏不明显时可仅表现为髓腔密度增高;少数骨病灶可有膨胀性表现,骨皮质穿破后可形成软组织肿块;全身骨病灶代谢不均匀增高,SUVmax=5.6±2.3;病理骨折处SUVmax=4.9±0.7;骨破坏区和代谢增高区可不一致;治疗后MM病灶代谢程度降低,PET所见变化早于CT形态变化;病理骨折处代谢增高,需和肿瘤活性残留相鉴别.结论:PET/CT有助于MM的鉴别诊断并早期评价病灶的疗效反应,具有重要临床应用价值.     

益肺活血复方对人肺动脉内皮细胞分泌功能的影响

目的研究益肺活血复方对人肺动脉内皮细胞分泌功能的影响。方法建立人肺动脉内皮细胞低氧高二氧化碳模型;制备益肺活血复方不同给药剂量（生药10、20、40 g.kg-1）的含药血清及生理氯化钠溶液血清;在细胞培养液中共同孵育12 h后,利用免疫组织化学法测定细胞内低氧诱导因子-1ɑ（HIF-1ɑ）的表达,放射免疫分析法测定各组细胞上清液中内皮素-1（ET-1）的浓度,逆转录多聚酶链反应法测定ET-1mRNA的表达水平。结果低氧高二氧化碳条件下,人肺动脉内皮细胞ET-1的分泌、HIF-1ɑ蛋白和ET-1mRNA的表达明显增强（P〈0.05）;而中、高浓度益肺活血复方能够抑制人肺动脉内皮细胞合成分泌HIF-1ɑ、ET-1mRNA及ET-1（P〈0.05）。结论低氧高二氧化碳导致人肺动脉内皮细胞功能障碍,而中、高浓度的益肺活血复方可减少人肺动脉内皮细胞ET-1的分泌和ET-1mRNA、HIF-1α蛋白的表达,从而减轻人肺动脉内皮细胞功能紊乱的程度,益肺活血复方可能成为治疗低氧高二氧化碳性肺动脉高压的有效药物。     

金纳多与茶多酚对缺氧诱导血管内皮细胞分泌内皮素的保护作用比较

目的观察缺氧对血管内皮细胞（VEC）分泌内皮素（ET）的影响及金纳多和茶多酚的保护作用。方法将VEC分为空白对照组、单纯缺氧组、缺氧＋金纳多组、缺氧＋茶多酚组。除空白对照组外,其他各组置于低压舱内进行缺氧暴露。用放免法测定各组缺氧前和缺氧后0．5、6、24h ET含量。结果（1）缺氧可促进VEC分泌ET增加（P〈0．01）。（2）同单纯缺氧组比较,在缺氧后0．5、6、24h时,金纳多组的ET含量明显低于缺氧组（P〈0．01）。（3）同单纯缺氧组比较,在缺氧后0．5h,茶多酚组的ET含量无显著性差异（P〉0．05）。在缺氧后6h和24h时,茶多酚组的ET含量明显低于缺氧组（P〈0．01）。（4）金钠多组与茶多酚组比较,金纳多组ET浓度在缺氧后0．5h较茶多酚组显著降低（P〈0．01）。在6h和24h两组比较无显著性差异（P〉0．05）。结论缺氧可显著增加VEC分泌ET;金纳多和茶多酚具有抑制缺氧促VEC分泌ET的作用。     

流式免疫分型在多发性骨髓瘤诊治中的应用进展

流式免疫分型作为血液系统肿瘤的一个重要的辅助检查手段,目前在多发性骨髓瘤（MM）的诊断,预后评估及微小残留病检测方面的价值,已经被越来越多的学者认同,本文就将在MM的免疫表型特点,在临床中的应用进展作一个综述。     

多发性骨髓瘤MRI表现与骨髓瘤细胞比值关系研究

目的　探讨多发性骨髓瘤(multiplemyeloma, MM)MRI表现与骨髓瘤细胞比值的关系。方法　对经骨髓涂片或活检确诊的 15例MM病人的脊柱MRI表现分型,分析各型与骨髓瘤细胞所占百分比、血红蛋白值的关系。结果　局灶型病变 7例,弥漫型 4例,“盐和胡椒面”型 4例。MRI表现分型不同,骨髓瘤细胞所占百分比值之间存在显著性差异 (Ρ=0. 008);血红蛋白值之间亦存在显著性差异(Ρ= 0. 03)。MM的脊柱弥漫型侵犯与高的骨髓瘤细胞比值及低的血红蛋白值相关。结论　脊柱MRI可反映MM的骨髓受累情况,其MRI表现与骨髓瘤细胞所占百分比值、血红蛋白值之间存在相关性。     

蛋白激酶C抑制剂Ro 31-8220对Hep 3B细胞产生纤维蛋白原的抑制作用

目的研究蛋白激酶C抑制剂Ro 31-8220对纤维蛋白原的作用.方法辣根过氧化酶标记纤维蛋白原,以酶联免疫方法测定Hep 3B细胞上清中纤维蛋白原含量.结果 LPS诱导的巨噬细胞条件培养基能刺激Hep 3B细胞分泌纤维蛋白原,蛋白激酶C抑制剂Ro 31-8220(10～1 000nmol*L-1)有抑制作用.结论蛋白激酶C抑制剂Ro 31-8220可抑制纤维蛋白原的产生.     

Comprehensive Updates in the Role of Imaging for Multiple Myeloma Management Based on Recent International Guidelines

The diagnostic and treatment methods of multiple myeloma (MM) have been rapidly evolving owing to advances in imaging techniques and new therapeutic agents. Imaging has begun to play an important role in the management of MM, and international guidelines are frequently updated. Since the publication of 2015 International Myeloma Working Group (IMWG) criteria for the diagnosis of MM, whole-body magnetic resonance imaging (MRI) or low-dose whole-body computed tomography (CT) and ¹⁸F-fluorodeoxyglucose positron emission tomography/CT have entered the mainstream as diagnostic and treatment response assessment tools. The 2019 IMWG guidelines also provide imaging recommendations for various clinical settings. Accordingly, radiologists have become a key component of MM management. In this review, we provide an overview of updates in the MM field with an emphasis on imaging modalities.