骨髓细胞形态学联合免疫固定电泳检测诊断多发性骨髓瘤的价值和不同ISS分期表达情况

The value of bone marrow cell morphology combined with immunofixation electrophoresis in the diagnosis of multiple myeloma and the expression of different ISS stages

目的探讨骨髓细胞形态学联合免疫固定电泳(IFE)检测诊断多发性骨髓瘤(MM)的价值和不同ISS分期表达情况.方法选取2018年3月-2020年2月天津市环湖医院收治的MM患者102例,按照International Staging System(ISS)分期分为Ⅰ期21例,Ⅱ期26例,Ⅲ期55例,均行细胞形态学检测和IFE检测,分析MM患者骨髓细胞形态学特征及IFE结果(IgG型、IgA型、IgM型、轻链型、未分泌型),对比不同ISS分期患者骨髓瘤细胞比例、M蛋白和骨髓细胞形态学阳性率,分析各指标与ISS分期的相关性.结果102例MM患者中,骨髓增生较为迅速99例,占比97.06%(99/102),骨髓增生降低3例,占比2.94%(3/102);骨髓瘤细胞比例>10%97例,占比95.10%(97/102),骨髓细胞形态变化显著,骨髓瘤细胞比例在5%-10%之间4例,占比3.92%(4/102),骨髓瘤细胞比例<5%1例,占比0.98%(1/102),为颅骨孤立性骨髓瘤;骨髓瘤细胞形态为成熟型53例,占比51.96%(53/102),骨髓瘤细胞形态为幼稚型39例,占比38.24%(39/102),骨髓瘤细胞形态为原始型6例,占比5.88%(6/102),骨髓瘤细胞形态为网状细胞型4例,占比3.92%(4/102);102例MM患者中采用IFE检测出IgG型64例,占比62.74%(64/102),IgA型26例,占比25.49%(26/102),IgM型7例,占比6.86%(7/102),轻链型3例,占比2.94%(3/102),未分泌型2例,占比1.96%(2/102);与Ⅰ期MM患者相比,Ⅱ期、Ⅲ期MM患者骨髓瘤细胞比例较高,与Ⅰ期、Ⅱ期患者相比,Ⅲ期MM患者骨髓瘤细胞比例较高(P<0.05);Ⅲ期患者M蛋白阳性率98.18%(54/55),较骨髓细胞形态学阳性率83.64%(46/55)高(P<0.05);Pearson分析结果显示,骨髓细胞比例(r=0.623)、M蛋白阳性率(r=0.486)、骨髓细胞形态学阳性率(r=0.591)和ISS分期呈正相关(P<0.05);102例MM患者中,经骨髓细胞形态学诊断出真阳性78例,IFE诊断出真阳性93例,二者联合诊断出真阳性100例,二者联合诊断灵敏性98.04%(100/102)较骨髓细胞形态学诊断76.47%(78/102)和IFE诊断91.18%(93/102)高(P<0.05).结论骨髓细胞形态学联合IFE检测诊断MM可确定免疫分型,评估病情分期与严重程度,有利于临床治疗MM和改善预后,临床应用价值高.

Objective To investigate the value of bone marrow cell morphology combined with immunofixation electrophoresis(IFE)in the diagnosis of multiple myeloma(MM)and the expression of different ISS stages.Methods 102 patients with MM treated in our hospital from March 2018 to February 2020 were selected according to the international staging system(ISS)were divided into 21 cases in stage 1,26 cases in stageⅡand.55 cases in stageⅢ.All of them were detected by cell morphology and IFE.The morphological characteristics of bone marrow cells and IFE results of MM patients were analyzed(IgG type,IgA type.IgM type,light chain type,non secretory type),the proportion of myeloma cells,the positive rate of M protein and bone marrow cell morphology in patients with different ISS stages were compared,and the correlation between each index and ISS stage was analyzed.Results Among 102 mm patients,99 cases had rapid bone marrow hyperplasia,accounting for 97.06%(99/102),and 3 cases had decreased bone marrow hyperplasia,accounting for 2.94%(3/102);97 cases with myeloma cell ratio>10%,accounting for 95.10%(97/102).The morphological changes of myeloma cells were significant.The proportion of myeloma cells was 5%-10%,accounting for 3.92%(4/102).1 case with myeloma cell ratio<5%,accounting for 0.98%(1/102),which was solitary myeloma of skull;53 cases with mature myeloma cell morphology,accounting for 51.96%(53/102),myeloma cell morphology was immature in 39 cases,accounting for 38.24%(39/102),myeloma cell morphology was primitive in 6 cases,accounting for 5.88%(6/102),myeloma cell morphology was reticular cell in 4 cases,accounting for 3.92%(4/102);in 102 MM patients,IgG type was detected by IFE in 64 cases,accounting for 62.74%(64/102),IgA type in 26 cases,accounting for 25.49%(26/102),there were 7 cases of IgM type,accounting for 6.86%(7/102),3 cases of light chain type,accounting for 2.94%(3/102),and 2 cases of non secretory type,accounting for 1.96%(2/102);compared with patients with stageⅠMM,the proportion of myeloma cells in patients with stageⅡandⅢMM was higher,compared with patients with stageⅠandⅡMM,the proportion of myeloma cehs in patients with stageⅢMM was higher(P<0.05);the positive rate of M protein in patients with stageⅢMM was 98.18%.The results of Pearson analysis showed that the proportion of bone marrow cells(r=0.623),the positive rate of M protein(r=0.486),the positive rate of bone marrow cell morphology(r=0.591)were positively correlated with ISS stage(P<0.05);among 102 MM patients,78 cases were diagnosed as true positive by bone marrow cell morphology,93 cases were diagnosed as true positive by IFE,and 100 cases were diagnosed as true positive by the combination of the two.The sensitivity of the combined diagnosis of the two was 98.04%(100/102),which was higher than that of 76.47%(78/102)and 91.18%(93/102)by bone marrow cell morphology and IFE(P<0.05).Conclusion Bone marrow cell morphology combined with IFE can determine the immune classification,evaluate the stage and severity of MM,which is conducive to the clinical treatment of mm and improve the prognosis.