浆细胞骨髓瘤非典型免疫表型特征及其意义

Characteristics and significance of atypical flow cytometric immunophenotype in plasma cell myeloma

目的：探讨流式细胞术检测浆细胞骨髓瘤的非典型免疫表型特征及其临床意义。方法采用病例对照性研究，收集中山大学孙逸仙纪念医院和暨南大学附属第一医院2011年1月至2013年12月住院或门诊非典型免疫表型特征浆细胞骨髓瘤患者48例。此48例非典型免疫表型特征浆细胞骨髓瘤患者为研究对象，42例免疫表型、骨髓形态学及血清免疫固定电泳结果均正常的病例作为对照组，运用流式细胞仪检测其特异性CD抗原标志，并根据非典型免疫表型特征浆细胞骨髓瘤患者流式检测结果，按照 CD38、CD138、CD19、CD56的表达情况将其分为 CD38＋/CD138＋/CD19＋/CD56＋、CD38＋/CD138＋/CD19＋/CD56-、CD38＋/CD138＋/CD19-/CD56-3组，进一步比较这3组胞浆内免疫球蛋白轻链（ cKappa、cLambda）表达情况，并结合骨髓形态学及血清免疫固定电泳结果进行分析比较。样本率的比较采用χ2检验。结果48例具非典型免疫表型特征浆细胞骨髓瘤患者中，抗原表达率分别为：CD4529.17％、CD38100％、CD138100％、CD1995.83％、CD5643.75％、cKappa 43.75％和 cLambda 56.25％。3组患者的克隆性免疫球蛋白表达率分别为43.75％、52.08％和4.17％；骨髓形态学及血清免疫固定电泳阳性率分别为57.14％、80％、100％及71.43％、88％、100％。流式细胞术、骨髓形态学及血清免疫固定电泳3种检测方法阳性检出率分别为100％、70.83％及81.25％。而对照组抗原表达率分别为：CD4547.62％、CD38100％、CD138100％、CD19100％、CD560％、cKappa 100％和cLambda 100％，骨髓形态学检查未见异常浆细胞，血清免疫固定电泳均未发现异常单克隆条带。结论多参数流式细胞术相对于骨髓形态学及血清免疫固定电泳的检测方法，更有助于检出非典型免疫表型的浆细胞骨髓瘤，更好地区分良恶性浆细胞，辅助临床对浆细胞骨髓瘤患者的诊断，为其治疗及预后监测提供依据。（中华检验医学杂志，2014，37：687-690）

Objective To investigate the characteristics and significance of atypical flow cytometric immunophenotype in plasma cell myeloma.Methods Using case-control study , 48 cases with atypical immunophenotype of plasma cell myeloma and 42 cases as control group were studied by flow cytometry , the former cases were classified into three groups according to the expression of CD 38, CD138, CD19, CD56 ：CD38 ＋/CD138 ＋/CD19 ＋/CD56 ＋, CD38 ＋/CD138 ＋/CD19 ＋/CD56 -, CD38 ＋/CD138 ＋/CD19 -/CD56 -.And compare the three groups with intracellular immunoglobulin light chain （cKappa, cLambda） , bone marrow morphology and immunofixation.The positive rate was compared with chi-square test.Results Bone marrow plasma cells showed expression of particular antigens in the following proportion of the 48 cases：CD45 29.17%, CD38 100%, CD138 100%, CD19 95.83%, CD56 43.75%, cKappa 43.75%and cLambda 56.25%.And in the three groups , the expression of monoclonal immunoglobulin were＆amp;nbsp;43.75%, 52.08%and 4.17%, which bone marrow morphology and immunofixation were 57.14%,80%, 100%and 71.43%,88%,100%.The positive rate of flow cytometry , bone marrow morphology and serum immunofixation electrophoresis were 100%, 70.83% and 81.25%.While the expression of particular antigens in the control group were：CD45 47.62%, CD38 100%, CD138 100%, CD19 100%, CD56 0%, cKappa 100% and cLambda 100%.And no abnormalities were detected in bone marrow morphology and immunofixation.Conclusions Compared with the bone marrow morphology and immunofixation , multiparameter flow cytometry has more helpful to find out atypical immune phenotype of plasma cell myeloma, and differentiate malignant and benign plasma cell , contributes to the diagnosis of clinical plasma cell myeloma, prognosis and treatment monitoring.