【作者】 张瑾；

【导师】 黄金文；

【作者基本信息】 浙江大学 ， 内科学， 2005， 硕士

【摘要】 前言 多发性骨髓瘤(multiple myeloma,MM)以单克隆浆细胞进行性增生并产生大量单克隆免疫球蛋白为特征。这些浆细胞浸润骨骼,引起骨骼的溶骨性破坏,表现为病理性骨折或骨质疏松。其它常见的临床表现包括贫血、高钙血症、肾功能损害和反复的细菌感染。在血液系统肿瘤中,多发性骨髓瘤的发病率占血液系统肿瘤的10%。该病的发病率已超过急性白血病,仅次于非霍奇金淋巴瘤,位居第二。尽管目前在我国尚无有关多发性骨髓瘤的流行病学资料,但随着我国人口老龄化的发展,多发性骨髓瘤的发病也有逐年增高的趋势。 Bence Jones蛋白的发现使得人们可以利用它作为疾病的直接标志物来诊断多发性骨髓瘤。近年来,细胞遗传学、分子遗传学以及分子免疫学中许多新的方法被引入多发性骨髓瘤的研究。现在,更多还原

【Abstract】 BackgroundMultiple myeloma(MM) is a neoplastic proliferative disease of a single clone of plasma cell which home to bone marraw,characterized by producing monoclone protein and osteolytic lesions. It’s a common hematological tumor and accounts for approximately 10 percent of heamatological malignancies. Now the diagnosis of multiple myeloma is depended to the plasma cell involving the bone marrow 、 other tissue and a mounte of monoclone immunoglobulin in the serum and urine ,and osteolytic lesions in the bone.,so it is caused the difficulties in the diagnosis of multiplemyeloma.the signs of multiple myeloma are very complex, the complains of patients are very difference ,so the patients may go to the other outpatient clinic that cause the mistake of diagnosis. The trational monoclonal immunobulin assay are serum and urine protein electrophoresis and the quantitative analysis of immunoglobumin.The sensitivity of these methods is not so high and can cause false positiveThe key to diagnosis multiple myeloma is to assay the monoclonal immunobulin exactly and sensitivitily. the common methods to check monoclonal immunobulin with immunology are:region electrophoresis 、 immuno-electrophoresis 、 immunofixation、 the immunoglobumin heavy chain gene clone rearray techniquesetc. we used 4 of these methods:the quantitative analysis of immunobumin、 serum and urine protein electrophoresis, 、 immunofixation、 κ or λ stain in the bone marrow biopsy to assess which is the better method to the dignosis of multiple myeloma.Patients and methodsFrom the year of 2003, patients who dignoseded as multiple myeloma were collected/there are 20 males and 11 females, the average age is 65.7 years.(50-79). we used cellulose acetate emembrane electrophoresis,immnnofixation electrophoresis , the tate nephelometric inhibition immunoassay with the Beckman array 360 systerm and used dimmunohistochemical En Vision method to assay the monoclonal k and X. Results and DiscussionIn the 17 cases that dignosed as IgG type multiple myeloma with the method of immunofixation electrophoresis,there are 15 cases whose total IgG are higher than normal range,other 2 cases are in the normal range,in the 7 cases that dignosed as IgA type multiple myeloma with the method of immunofixation electrophoresis,there are 6 cases whose total IgA are higher than normal range,other lcase is in the normal range,In the lcases that dignosed as IgM type multiple myeloma with the method of immunofixation electrophoresis,the IgM is higher than normal range, In the 6cases that dignosed as light chain type multiple myeloma with the method of immunofixation electrophoresis,theirKor are higher than normal range.In the 31 cases, 18 cases whose M protein in the y region of the serume protein electrophoresis,4 cases whose M protein in thep region of the serume protein electrophoresis, 1 case whose M protein between the and region of the serume protein electrophoresis 1 case whose M protein in the aregion of the serume protein electrophoresis.The monoclonal immunoglobumine can be found in the all 31 cases using immunofixation electrophoresis, the M protein can be found in all IgG and IgM type multiple myeloma patients with serume electrophorasis,the sensitivity to the M protein in the IgA and light chain type with serume electrophorasis is low,only 54% so immunofixation electrophoresis is a first choice.to the diagnosis of the multiple myeloma.In the multiple myeloma patient’s bone marrow biopsy specimen,A large amount of monoclonal light chain or can be found by staited,78% positive result was found in the 31 patients.From the Bergon’s conclusion,that the kappa/lambda ratio 4: 1 or 1: 4 shows multiple myeloma. In the 31 cases 64% patients have this positive result. Conclusions1. The checkout rate of IgG and IgM monoclonal immunoglobumin were high by serum protein electrophoresis which had appliacation limit on other types.2. kappa or lambda stain positive in bone marrow biopsy may be a good method to check out the monoclonal immunoglobumin.3. All更多还原