实验室检查在多发性骨髓瘤临床诊断中的价值

目的了解各种实验室检查在多发性骨髓瘤(MM)临床诊断中的价值。方法对2007年2月～2011年2月临床诊断为多发性骨髓瘤的26例患者血清蛋白电泳、免疫固定电泳、血清总蛋白、免疫球蛋白及尿本-周氏蛋白、骨髓细胞学检测结果进行回顾性分析。结果血清蛋白电泳分析发现26例MM均检出M带,免疫固定电泳结果显示:IgG型16例(61.5%),为最多类型,其中IgGκ型10例(38.5%),IgGλ型6例(23.1%);IgA型7例(26.9%),其中IgAκ型5例(19.2%),IgAλ型2例(7.7%);IgM型1例(3.8%),为κ型;轻链型2例(7.7%),均为λ型。IgG型M带多出现在γ区,IgA型M带多出现在在β区。各类型M蛋白阳性患者对应Ig的血清浓度均显著升高;轻链型各种Ig含量均降低。23例血清总蛋白升高。26例尿本-周氏蛋白检测均为阴性。16例行骨髓细胞学检查的患者14例骨髓浆细胞质与量的改变均符合诊断标准。结论血清总蛋白、免疫球蛋白检测对临床诊断MM具有重要的提示作用;血清蛋白电泳因其灵敏度高、速度快且图谱清晰直观,是很好的M蛋白临床筛查实验;免疫固定电泳因其特异性好、灵敏度高,对MM的诊断分型和临床分期具有重要意义。

Value of laboratory data in the clinical diagnosis of multiple myeloma

Objective To study the values of laboratory data in the clinical diagnosis of multiple myeloma（MM）.Methods Serum protein electrophoresis（SPE）,immunofixation electrophoresis（IFE）,serum total protein,globulin,urine B-J protein results of 26 MM patients diagnosed during February 2007 to February 2011 were reviewed.Results M protein was detected in all of 26 cases with SPE.IFE manifested that：there were IgG kappa 10 cases（38.5%）,IgG Lambda 6 cases（23.1%）,IgA kappa 7 cases（26.9%）,IgA Lambda 5 cases（19.2%）,IgM Lambda 1 case（3.8%）,and Lambda light chain 2 cases（7.7%）.M proteins of IgG type were mostly detected in γ region,while those of IgA type were mostly detected in β region.Except for light chains in which all types of immunoglobin were lower than normal,the immunoglobin of other types of M protein were distinguished high respectively.All B-J protein tests were negative.14 among 16 cases with bone marrow morphology tests were up to standard of MM.Conclusion Serum protein tests can be used as a suggestion of MM.SPE was simple and quick method with high sensitivity for screening MM.IFE was suitable for identifying and typing MM with high specificity and sensitivity.