减少多发性骨髓瘤误诊漏诊的简便过筛指标

Studies on Simple Screening Indexes to Reduce Misdiagnosis and Missed Diagnosis of Multiple Myeloma

多发性骨髓瘤（ＭＭ）由于起病隐匿，误诊率高，因此，建立减少多发性骨髓瘤误诊漏诊的简便过筛试验十分重要。ＭＭ关键的病理生理变化是骨髓瘤细胞产生大量的异常免疫球蛋白。高水平的异常免疫球蛋白导致患者血清总蛋白、球蛋白含量明显升高，异常免疫球蛋白包裹凝血因子和血小板，引起患者凝血功能障碍。据此，我们确定将临床常规化验项目肝功能试验中血清总蛋白＞９５ｇ／Ｌ、球蛋白＞５５ｇ／Ｌ、血块收缩不佳作为过筛指标，纠正了临床１２例ＭＭ的误诊，结果与骨髓细胞学检查符合率达１００％。尽管此过筛系统不适于仅占ＭＭ总数１％的非分泌型骨髓瘤和极少低水平异常免疫球蛋白血症的骨髓瘤病人，但只要过筛试验阳性，即提示ＭＭ的诊断。这一简便过筛系统值得临床推广应用。

Due to rare incidence,latent onset and complex clinical manifestation,the rate of misdiagnosis of Multiple Myeloma(MM)was high Therefore it is imperative to develop a simple screening test to reduce the rate of misdiagnosis or missed diagnosis of MM The key pathophy siological course of MM is the production of abnormal globulin in large quantities by myeloma cells The high level of abnormal globulin in MM patients blood accounts for the high level of serum total protein and globulin And the coagulation factors and platelet wrapped by the abnormal globulin accounts for disfunction of blood coagulation So the critical values of the clinical routine liver function test,i e serum total protein >95g/L,globulin >55g/L and defective blood clot retraction were selected as the screening indexes By these indexes,we offered initiative help to correct 12 misdiagnosed MM The agreement rate of MM diagnosed by the indexes and by bone marrow cytologic examination was 100%.As soon as thescreening indexes were positive,MM could be diagnosed except for the cases of non secretory myeloma which occupied only 1% of MM and low level abnormal Ig myeloma which was rare These simple screening indexes are worthy to be spread for clinical application