皮肤病住院患者568例M蛋白检测结果分析

Distribution of M-proteinemia in inpatients with dermatoses

目的:探讨M蛋白血症在皮肤病患者中的分布。方法:对2011年1月—2016年12月在武汉市第一医院住院的568名皮肤病患者M蛋白检测结果及临床资料进行分析。结果:568例患者中,男性319例,女性249例,年龄1~92岁。送检M蛋白的皮肤病包括结缔组织病、大疱性皮肤病、皮肤血管炎、脂膜炎、红斑及红斑鳞屑性皮肤病、变态反应性皮肤病、感染性皮肤病、代谢性皮肤病及皮肤肿瘤等。共检出M蛋白阳性患者23例,阳性率为4.05%,其中男性13例,女性10例,年龄47~84岁。阳性患者主要分布于坏疽性脓皮病、变应性皮肤血管炎、嗜酸性粒细胞增多性皮病、红皮病及角层下脓疱病中。M蛋白类型包括IgA、IgG、IgM及双克隆型,其中以IgA-λ型最常见。7例患者进一步行骨髓穿刺检查,其中2例M蛋白阳性患者并发恶性血液病(1例嗜酸性粒细胞增多性皮炎并发B细胞淋巴瘤,1例带状疱疹并发急性粒细胞白血病),另5例患者均符合意义未明的单克隆免疫球蛋白血症。结论:对于坏疽性脓皮病、角层下脓疱病等嗜中性皮病、变应性皮肤血管炎、伴明显嗜酸性粒细胞增高的皮炎湿疹类疾病可以检测M蛋白,以探讨其与这些疾病的相关性。

Objective： To investigate the distribution and clinical significance of M-proteinemia in patients with dermatoses. Methods： From January 2011 to December 2016, blood M protein and clinical data were analyzed in 568 inpatients, includ- ing 319 males and 249 females aged 1 to 92 years old. Skin diseases included connective tissue disease, bullous skin dis- eases, skin vasculitis, panniculitis, erythema skin diseases, erythema and scaly skin diseases, allergic skin diseases, infectious skin diseases, dermatoses of metabolism disturbance, and skin tumors, etc. Results： The blood M protein was positive in 23 patients（4.05%）, including 13 males and 10 females aged 47 to 84 years old. Dermatoses in patients with M protein-positive were mainly pyoderma gangrenosum, allergic cutaneous vasculitis, eosinophilic dermatosis, erythroderma and subcorneal pustu- losis. The types of M protein included IgA, IgG, IgM, and double clones. IgA-lambda was the most common type. Among 7 M protein-positive patients, bone marrow examination showed malignant hematologic diseases in 2 patients （one hypere- osinophilic dermatitis with B cell lymphoma, one herpes zoster complicated with acute myelogenous leukemia）, and monoclon- al gammopathy in the other 5 patients. Conclusions： It is necessary to perform M protein test in patients with pyoderma gangrenosum, subcorneal pustulosis and neutrophilic dermatosis, allergic cutaneous vasculitis, dermatitis or eczema with eosinophilia, in order to delineate the association of these disorders with M protein.