【摘要】 目的探讨多参数流式细胞术(MFC)在多发性骨髓瘤患者初诊和微小残留疾病的检测意义。方法采用多参数流式细胞技术,通过CD138或CD38抗原标记识别74例多发性骨髓瘤患者的浆细胞,联合CD45、CD56、CD19、CD20、CD117表面抗原标记及胞浆Kappa和Lambda轻链鉴别异常骨髓瘤细胞。结果 44例初诊病例中,CD138在可检测的病例中均呈阳性表达,同时CD19阴性,42例病例(95%)CD45阴性或弱阳性,其他表面抗原标记CD38、CD56、CD20、CD117的检测率分别为98%、93%、45%、41%,胞浆Kappa和Lambda轻链均呈限制性克隆型表达。14例病例用于评估初诊及治疗过程中免疫表型的变化,其中11例病例(79%)出现至少1个及以上异常表型的变化,4例(29%)病例化疗后抗原标记荧光强度显著增加,7例(50%)病例荧光强度显著降低。CD45、CD19、胞浆免疫球蛋白轻链为最稳定的标记,未见显著抗原标记的变化,2例CD38(14%)、7例CD56(50%)、4例CD20(29%)及2例CD117(14%)病例呈现显著的抗原密度的变化。30例已治疗病例用于评估MRD的免疫表型,其中25例检测出异常的瘤细胞,5例病例未见显著的限制性轻链克隆型表达,Kappa与Lambda比值在0.5~2,认定MRD阴性。结论流式细胞术用于多发性骨髓瘤的诊断疗效及预后的判断具有重要意义,采用胞浆免疫球蛋轻链的检测可提升微小残留检测的正确性。更多还原

【Abstract】 Objective To investigate the detectable significance of multiparameter flow cytometry(MFC)for the first visiting and minimal residual disease(MRD)in the patients with multiple myeloma.Methods MFC was used to identify the plasma cells by the expression of CD138 or CD38antigen in 74 patients with multiple myeloma.By combining surface antigens like CD45,CD56,CD19,CD20,CD117 and the cytoplasm Kappa and Lambda light chain,the aberrant myeloma cells were differentiated from normal plasma cells.Results In the 44 first visiting cases,the positive expression of CD138 can be detected in all cases,while the expression of CD19 was negative and 42cases(95%)were negative or weak positive expression for CD45.The detection rates of CD38,CD56,CD20 and CD117were 98%,93%,45% and 41%,respectively.The cytoplasm Kappa and Lambda light chains were showed the limited expression.Of the patients with MM,14 cases were used for evaluating the change of immunophenotype at first visiting and during the treatment process,among them,11cases(79%)appeared the changes in at least one of aberrant phenotypes.4cases(29%)had the significant enhancement of antigen marker fluorescence intensities after chemotherapy and 7cases(50%)had significant decrease of antigen marker fluorescence intensities after chemotherapy.CD45,CD19 and cytoplasm immunoglobulin light chains were the most stable marker,no obvious antigen marker changes were found during the treatment,while there was a significant antigen density change in 2cases of CD38(14%),7cases of CD56(50%),4cases of CD20(29%)and 2cases of CD117(14%).Of the 30 cases for evaluating MRD immunophenotype,the abnormal myeloma cells were detected in 25 cases.In 5cases,no expression of limited Kappa and Lambda light chains was found and the ratio of Kappa and Lambda was 0.5-2,which were identified as negative for MRD.Conclusion The multiparameter flow cytometry has important significance in evaluating the diagnosis,therapeutical effect and prognosis.The detection by adopting cytoplasm immunoglobulin light chains can improve the accuracy in MRD detection.更多还原