改良培养法对提高老年多发性骨髓瘤患者染色体异常克隆检出率的研究

Effect of a modified culture method on detection rate of karyotype anomalies in elderly patients with multiple myeloma

目的评价改良培养方法在老年多发性骨髓瘤（multiplemyeloma，MM）患者中能否提高染色体异常克隆的检出率，同时探讨染色体核型异常与老年MM患者临床特征的关系。方法取我院2011年1月至2012年6月28例MM患者的骨髓标本，同时以常规24h短期培养法和改良6d长期培养法，培养基中添加白介素6（interleukin6，II。一6）10,ug／L和粒一单细胞刺激因子（granulocyte—macrophagecolony-stimulatingfactor，GM—CSF）40／,g／L。然后采用G显带法进行染色体核型分析。结果28例行常规24h短期培养法组中，4例患者未见分裂相，检测失败率14．3％；有分裂相的24例患者中，6例发现核型异常，染色体异常克隆检出率为25．0％。改良6d长期培养组中，28例中仅1例患者未见分裂相，检测失败率3．6％；27例有分裂相的患者中，15例检出有异常克隆存在，异常克隆检出率55．6％，两组染色体异常克隆检出率差异有统计学意义（x2=4．89，p〈0．05）。在可供分析的27例患者中，20例为初诊或进展期患者，7例为疾病稳定期的患者，初诊或进展期患者染色体异常克隆检出率为70．0％（14／20），稳定期的患者染色体异常克隆检出率为14．3％（1／7），前者染色体异常克隆检出率高于后者，经Fisher精确检验P〈0．05。结论6d改良培养法可提高老年多发性骨髓瘤患者染色体异常克隆检出率，优于24h常规培养法。初诊、进展期患者的染色体异常克隆检出率高于稳定期患者。

Objective To evaluate the effect of a modified culture method on the karyotype anomalies detection rate in elderly patients with multiple myeloma （MM）, and to explore the relationship between clinical characteristics and chromosome anomalies in multiple myeloma. Methods Two culture methods were applied on the bone marrow samples which obtained from 28 MM patients. One method was used to culture cells for 24 hours with interleukin 6 （IL-6） 10 ptg/L and granulocyte-macrophage colony-stimulating factor （GM-CSF） 40 /,g/L, and the other for 6 days. Karyotype was analyzed by G-banding technique. Results In the 24-hour culture group, no metaphases cell was found in 4 cases （14.3 ~/00 ）, karyotype anomalies were found in 6 cases in the other 24 cases, and the detection rate was 25.0% （6/24）. In the 6-day culture group, no metaphases cell was found in 1 patient （3.6G）, karyotype anomalies were found in 15 cases in the other 27 patients, and the detection rate was 55.6~ （15/27）. There was a significant difference in the detection rate of karyotype anomalies between the two groups （Z2 = 4.89, P （0.05）. In 27 cases with enough metaphases in the 6 day culture group, 20 cases were newly diagnosed or in progression, among whom karyotype anomalies were found in 14 cases （70.0~//0, 14/20）, and 7 cases were in stable phase, among whom karyotype anomalies were found in 1 case （14.30%, 1/7）. The detection rate of abnormal karyotype was higher in newly diagnosed or in progressive patients than in stable patients （P 〈0.05）. Conclusions 6-day culture method can improve the detection rate of karyotype anomalies in elderly patients with multiple myeloma, which is better than 24-hour culture method. The detection rate of karyotype anomalies is higher in newly diagnosed or in progressive patients than in stable patients.