多发性骨髓瘤免疫表型及胞浆轻链检测的临床意义

The clinical significance of Immunophenotype and Cytoplasmic light chain's detection in Multiple Myeloma

目的研究多发性骨髓瘤(multiple myeloma,MM)细胞的免疫表型特点及胞浆内轻链的表达。方法采用四色流式细胞仪,用CD45-APC/SSC及CD38/CD56联合设门,对45例MM患者的骨髓标本进行CD38、CD56、CD19、CD138、CD45、轻链(κ链、λ链)及胞浆内轻链(cκ链、cλ链)的检测。结果 45例骨髓瘤患者中分泌型为37例(其中IgG型为27例,IgA型为10例),轻链型为5例(λ链型4例,κ链型1例),不分泌型3例,其免疫表型出现的频率为:其中表型为CD38+CD56+CD19-CD45-:分泌型为37/37(100%),轻链型2/5(40%),不分泌型0/3(0%),表型为CD38+CD56-CD19-CD45-:轻链型3/5(60%),不分泌型3/3(100%),CD138+:45/45(100%),膜表面轻链(κ链、λ链):0/45(0%),胞浆轻链(cκ链、cλ链):45/45(100%),其中分泌型:cκ链10/37(27%);cλ链:27/37(73%);轻链型:cκ链1/5(20%);cλ链:4/5(80%);不分泌型:cκ链1/3(33%);cλ链:2/3(67%)。结论用流式细胞术分析多发性骨髓瘤的细胞免疫表型及胞浆轻链的表达对骨髓瘤的临床诊断有很大的帮助,特别是对不分泌型的骨髓瘤诊断的临床价值更大。

Objective Objective To study the immunophenotype characteristics and the expression of cytoplasmic light chian in Multiple Myeloma（MM） cells.Methods The samples of bone marrow aspiration from 45 MM patients were collected and used for the detection of CD38,CD56,CD19,CD138,CD45,and membrane light chains（κ/λ chain） with flow cytometry（a combination of CD45-APC/SSC and CD38/CD56）.In addition,cytoplasmic light chains（cκ/cλ chain） were detected as well.Results Among 45 MM patients,37 of them belonged to secretory type（27 of 37 was IgG type and 10 of 37 was IgA type）,5 of them belonged to light chain type（4 was λ chain and 1 was κ chain）,and 3 of them belonged to un-secretory type.The frequency of immunophenotype characteristics showed that：100%（37/37）secretory type,40%（2/5） of light chain type and 0%（0/3） un-secretory type showed the phenotype of CD38＋CD56＋CD19-CD45.60%（3/5） of light chain type and 100%（3/3） un-secretory type showed the phenotype of CD38＋CD56-CD19-CD45.All the samples（45/45） showed CD138＋ and none of any sample（0/45） showed positive membrane light chain.In addition,all the samples（45/45） also showed the phenotype of cytoplasmic light chain：27%（10/37） secretory type,20%（1/5） light chain type and 33%（1/3） un-secretory type showed positive cκchain;73%（27/37） secretory type,80%（4/5） light chain type and 67%（2/3） un-secretory type showed positive cλchain.Conclusion It would be helpful for the clinical diagnosis of MM patients with the method of flow cytometry to detect the immunophenotype characteristics and cytoplasmic light chain,especially for the un-secretory type MM patients.