不分泌型多发性骨髓瘤11例的临床及实验室特点

The clinical and laboratorial characteristics of eleven nonsecretory myeloma

目的加深对不分泌型多发性骨髓瘤（NSM）的临床及实验室特点的认识。方法对11例NSM患者进行免疫球蛋白IgG、IgA、IgM、IgD、IgE及轻链，血清蛋白电泳（PE），免疫固定电泳（IFE）及血清游离轻链（FLC）检测。结果11例患者均有严重多处骨骼疼痛，均有溶骨性骨质破坏。PE、IFE、尿FLC检测均为阴性。2例初治患者血清FLC升高，κ／λ比值均异常；1例平台期患者FLC正常。11例患者骨髓浆细胞均〉30％。其总生存时间与典型多发性骨髓瘤（MM）相同。结论NSM均有多处严重骨骼疼痛，均有溶骨性骨质破坏。PE、IFE、尿FLC检测均为阴性。初治、复发时血清FLC升高，κ／λ比值异常；平台期FLC正常或降低。NSM患者的骨髓浆细胞均〉30％。NSM的治疗和预后与典型MM相同。

Objective To get more understanding on the symptom, and laboratory characteristics of nonsecretory myeloma（NSM）. Methods 11 patients with NSM were examined by immunoglobulins IgG, IgA, IgM, IgD, IgE and their light chains, electrophoresis（PE）, immunofixation electrophoresis（IFE） and serum free light chain（FLC）. Results All 11 patients had more serious bone pains, all had osteolytic bone lesions . All patients were negative in PE, IFE, urine FLC tests. 2 newly diagnosed patients had increased serum FLC, abnormal κ/λ ratio.1 patient had normal serum FLC and normal κ/λ ratio. All 11 patients had more than 30 % bone marrow plasma cells .Their overall survivals were same with the typical multiple myeloma （MM）. Conclusion Most NSM have more serious bone pains, and osteolytic bone lesions. PE, IFE, urine FLC tests are negative. Newly diagnosed or refractory patients have increased serum FLC, abnormal κ/λ ratio, plateau phase patients have normal or reduced serum FLC . Most NSM have more than 30 % bone marrow plasma cells. The therapy and prognosis of NSM are same with typical MM.