多发性骨髓瘤患者浆细胞免疫表型特点及其临床意义研究

目的:观察多发性骨髓瘤(MM)患者骨髓中浆细胞免疫表型特点,及其与患者临床预后的相关性。方法:收集35例MM患者资料,骨髓涂片及切片分别经瑞氏-吉姆萨和HE染色后,观察分析骨髓细胞形态及病理学特点。同时,取患者骨髓或外周血分别进行流式细胞术检测及相关实验室检查。结果:MM患者骨髓浆细胞不仅数量明显增多,且形态明显异常,切片中浆细胞分布类型包括塞实型16例(45.71%),结节型14例(40.00%)和间质型5例(14.29%)。MM患者中出现血清LDH、β2-MG、Cr和BUN等检测指标升高的比例分别占80%、85.71%、62.86%和60%。MM患者浆细胞CD38、CD138均呈阳性表达,CD56、CD200、CD117和CD28阳性患者比例分别为65.71%、94.29%、60%和54.29%,CD20、CD81、CD33、CD27及CD13阳性患者比例分别为37.14%、42.86%、28.57%、57.14%和34.29%,而CD19及CD45阳性患者比例分别为22.86%和31.42%,且Igκ或Igλ链表达缺失呈单克隆增生。其中CD27和CD28的表达情况与MM患者预后密切相关,浆细胞CD27表达缺失及CD28阳性表达的患者5年总生存率较低(P<0.05)。结论:MM患者骨髓中浆细胞免疫表型明显异常,其中CD27和CD28的表达与患者病情进展和临床预后具有显著相关性,因此免疫表型检测在MM患者临床诊断、治疗监测中具有重要意义。

Immunophenotype characteristics of plasma cells and clinical significance in multiple myeloma patients

OBJECTIVE: To determine immunophenotype characteristics of plasma cells in bone marrow of multiple myeloma (MM) patients and to correlate with clinical prognosis. METHODS: Bone marrow smears and sections were stained with Wright Giemsa and HE,respectively,and their morphological and pathological characteristics were analyzed. In addition,bone marrow or peripheral blood samples were collected for flow cytometry immunophenotyping and related laboratory tests. RESULTS: There was a significantly increased number of bone marrow plasma cells in MM patients and marked morphological abnormality. Their distributions included plug solid type in 16 cases (45.71%),nodular type in 14 cases (40.00%) and interstitial type in 5 cases (14.29%). Proportion of increased serum LDH,β2-MG,Cr and BUN in MM patients was 80%,85.71%,62.86% and 60%,respectively. There was positive expression of CD38 and CD138 in the plasma cells. The absence of expression of Igκor Igλ chain was monoclonal hyperplasia. The positive rates of CD56,CD200,CD117 and CD28 were 65.71%,94.29%,60% and 54.29%,respectively,and those of CD20,CD81,CD33,CD27 and CD13 were 37.14%,42.86%,28.57%,57.14% and 34.29%,respectively,as opposed to 22.86% and 31.42% in CD19 and CD45,respectively. The expressions of CD27 and CD28 were closely related to prognosis of MM patients,and the 5-year overall survival rate was lower in patients with the loss of CD27 expression in plasma cells and the positive expression of CD28 (P < 0.05). CONCLUSION: Abnormal immunophenotype was observed in plasma cells from bone marrow of MM patients,and expressions of CD27 and CD28 were significantly correlated with disease progression and prognosis. Therefore,immunophenotype detection can be of great significance in clinical diagnosis and treatment monitoring of MM patients.