44例多发性骨髓瘤实验室指标及Ig类型改变的分析

目的探讨骨髓细胞形态学检查结合血清蛋白电泳、免疫固定电泳、免疫球蛋白定量检查诊断多发性骨髓瘤，并探讨Ig类型改变的原因．方法对44例多发性骨髓瘤患者的骨髓细胞形态学检查、血清蛋白电泳、免疫固定电泳及免疫球蛋白的数据进行统计分析．结果44例MM患者中，骨髓瘤细胞〈10％的有40例（90．9％），且浆细胞具有较高的异质性；血清蛋白电泳检出M蛋白带的比例为88．6％；免疫固定电泳检出率为100％，免疫分型IgG占50％，IgA占20．5％，IgM占2．2％，轻链型占27．3％；免疫球蛋白定量显示同型的免疫球蛋白含量显著升高，但轻链型的各免疫球蛋白含量却正常或降低．其中1例MM患者骨髓移植后出现Ig类型转换．结论综合各实验室指标，可以最大程度减少多发性骨髓瘤的漏诊、误诊，Ig类型的改变对多发性骨髓瘤的临床诊断及治疗有再要意义．

Analysis of Laboratory Tests and Ig Class Switch in 44 Patients with Multiple Myeloma

Objective To investigate the diagnosis of MM （ multiple myeoloma） by the morphological examination of bone marrow combined with serum protein electrophoresis, immunofixation electrophoresis and quantitation of immunoglobulin, and to discuss the cause of Ig class switch. Method The data of the morphological examination of bone marrow, serum protein electrophoresis, immunofixation electrophoresis, quantitation of immunoglobulin from 44 patients with MM were analyzed statistically. Result In 44 patients with MM, there were 40 patients whose proportion of myeloma cells was 〈 10% （ 90.9% ）, and the plasma cells were high alloplastic ; The detection rate of M protein by serum protein electrophoresis was 88.6% ;The detection rate of M protein by immunofixation electrophoresis was 100%, monoclonal IgG accounted for 50%, IgA for approximately 20.5% , IgM for approximately 2.2% ,and monoclonal light chain for approximately 27.3% ;The results from quantitation of immunoglobulin showed that the content of the immunoglobulin with the same type significantly increased, but the contents of various immunoglobin with simple light chain were normal or slightly reduced. One case of MM patients showed Ig class switch after bone marrow transplantation. Conclusion Comprehensively analyzing the various laboratory indexes could reduce the missed diagnosis and misdiagnosis of MM. The observation of Ig class switch should be important for the clinical diagnosis and treatment of MM.