【摘要】 目的分析多发性骨髓瘤(multiple myeloma,MM)患者骨髓细胞形态和免疫型特征,为临床准确诊断提供依据。方法采用病例对照研究。收集2007年4月至2013年6月甘肃省人民医院初诊的MM患者88例(MM组),同时以88例增生性贫血患者为对照(贫血组)。用免疫固定电泳测定其单克隆抗体。分别用光学显微镜和四色流式细胞术检测分析其骨髓细胞形态和免疫型,并比较不同百分比的骨髓瘤细胞组间免疫型表达,以评价MM组免疫型特征。结果 88例MM患者经免疫固定电泳检测,Ig G型52例、Ig A型26例、Ig M型4例,Kappa轻链型52例、Lambda轻链型30例,6例阴性,贫血组无单克隆抗体表达。MM组形态学与贫血组(中位数0/200个)相比,前者浆细胞中幼稚细胞偏多,外形、胞浆、胞核均发生改变,且骨髓瘤细胞比例明显增高(中位数25/200个,t=14.177,P<0.05)。流式细胞术免疫分型结果:MM组CD38+98.86%(87/88例)、CD138+97.73%(86/88例)、CD56+76.14%(67/88例)、CD184+73.86%(65/88例),部分伴HLA-DR、CD19、CD20抗原表达,阳性率分别为44.32%(39/88例)、18.18%(16/88例)、15.91%(14/88例),MM组与贫血组比较,差异均有统计学意义(P<0.05);其他抗原分子(CD5、CD33、CD11b)不表达。用胞质染色法检出Kappa轻链阳性52例[59.09%(52/88例)]、Lambda轻链阳性30例[34.09%(30/88例)],与贫血组比较[0.00%(0/88例)],差异均有统计学意义(P=0.000),且与免疫固定电泳的结果相一致(Kappa值=-0.199,P=0.03)。此外,不同百分比的骨髓瘤细胞组间免疫型表达CD38、CD138、CD56、CD184、HLA-DR、CD19、CD20、Kappa、Lambda抗体的组间差异均无统计学意义(Fisher检验,P值分别为0.227、0.230、0.778、0.789、0.113、0.194、0.292、0.938、0.809)。结论骨髓细胞形态学是MM诊断的基本手段,结合免疫分型检测相关抗原分子,可协助临床客观准确地诊断MM。更多还原

【Abstract】 Objective To analyze the characteristics of the bone marrow cell morphology and immunophenotype in multiple myeloma(MM) patients and to provide a powerful evidence for clinical diagnosis of MM. Methods Case-control method was used in this study, it contained 88 newly diagnosed MM patients as experiment group(MM group) and 88 hyperplastic anemia patients as control group(anemia group) in Gansu Provincial Hospital from April 2007 to June 2013. Immune fixation electrophoresis was used to detect the specific monoclonal antibody. The optical microscope and four-color flow cytometry were used to test the bone marrow cell morphology and different antigen phenotype. Results The electrophoresis results showed that the expression of Ig G, Ig A, Ig M, Kappa light chain, Lambda light chain in 88 MM group was 52, 26, 4, 52, 30 respectively, and 6 cases were negative. Meanwhile, there was no positive type in anemia group. Compared morphology of MM group with anemia group(median was 0/200), the proportion of myeloma cells was significantly increased in diagnosed MM patients(the median was 25/200, t=14.177, P < 0.05). And the morphology characteristics was different from plasma cells, which were inclined to immature plasma cells, and the shapes, endochylema or nucleus all be changed. The result of multiparamete flow cytometry suggestted that there were CD38+98.86%(87/88cases), CD138+97.73%(86/88 cases), CD56+ 76.14%(67/88 cases), CD184+ 73.86%(65/88 cases), and some of cases also expressed CD19+, CD20+, HLA-DR+, CD34 and positive rate were 44.32%(39/88 cases), 18.18%(16/88 cases), 15.91%(14/88 cases) respectively; Compared with the MM group, the difference was statistically significant in the anemia group(P<0.05). No other antigen molecules(such as CD5, CD33 and CD11b) were expressed. The intracellular staining results showed that Kappa light chain-positive cases were 59.09%(52/88 cases), and Lambda light chain-positive were 34.09%(30/88 cases), there was a statistical significance(P<0.05), and the results were consistent with the immune fixation electrophoresis results(Kappa=-0.199, P=0.03). In addition, there was no difference between different proportion of myeloma cell groups in the expression of CD38, CD138, CD56, CD184, HLA-DR, CD19, CD20, Kappa, Lambda(Fisher test, P was 0.227, 0.230, 0.778, 0.789, 0.113, 0.194, 0.292, 0.938 and 0.809). Conclusions Bone marrow cell morphology test is a basic method for the diagnosis of MM. Using the immunophenotype to detect the cell-associated antigen molecules may provide a more accurate evidence for the diagnosis of MM.更多还原