骨髓细胞形态学与多参数流式细胞术在多发性骨髓瘤检测中的应用

Application of bone marrow cell morphology and multiparameter flow cytometry in the detection of multiple myeloma

目的探讨骨髓细胞形态学与多参数流式细胞术这两种方法在多发性骨髓瘤(MM)诊断中的应用价值。方法选取2019年10月至2021年5月于该院就诊的MM患者36例为研究对象,其中初诊患者19例(新发组),复查患者17例(复诊组)。根据骨髓细胞形态学检测出浆细胞比例的结果将36例MM患者分成以下3组:A组浆细胞比例≥30%;B组浆细胞比例在10%~<30%;C组浆细胞比例<10%。分析两种方法检测MM患者浆细胞比例的相关性、差异性、诊断敏感性,以及多参数流式细胞术检测cKappa/cLambda的阳性例数。比较MM患者新发组和复诊组两种方法检测的敏感性。结果两种方法检测浆细胞比例的结果呈正相关(r=0.786,P<0.05)。骨髓细胞形态学检测浆细胞比例的结果为(25.72±8.33)%,多参数流式细胞术检测浆细胞比例的结果为(11.48±3.29)%,差异有统计学意义(P<0.05)。A、B、C这3组中多参数流式细胞术检测浆细胞比例的敏感性分别为80.00%、50.00%、0.00%,骨髓细胞形态学检测浆细胞比例的敏感性分别为100.00%、100.00%、0.00%。两种方法在新发组和复诊组中的敏感性比较,差异无统计学意义(P=0.833、0.825)。采用多参数流式细胞术检测C组cKappa/cLambda的阳性例数有12例。结论骨髓细胞形态学与多参数流式细胞术的联合应用可以提高MM异常浆细胞的检测率,减少漏诊率。

Objective To investigate the value of bone marrow cell morphology and multiparameter flow cytometry in the diagnosis of multiple myeloma(MM).Methods A total of 36 MM patients who were treated in this hospital from October 2019 to May 2021 were selected as the research objects,including 19 newly diagnosed patients(new-onset group)and 17 reexamination patients(follow-up group).According to the results of the proportion of plasma cells detected by bone marrow cell morphology,36 patients with MM were divided into the following three groups:the proportion of plasma cells in group A was≥30%;the proportion of plasma cells in group B was 10%-<30%;the proportion of plasma cells in group C was<10%.The correlation,difference and diagnostic sensitivity of the two methods for detecting the proportion of plasma cells in MM patients,as well as the number of positive cases of cKappa/cLambda detected by multiparameter flow cytometry were analyzed.The sensitivity of the two methods was compared between the new-onset group and the follow-up group of MM patients.Results The results of the two methods for detecting the proportion of plasma cells were positively correlated(r=0.786,P<0.05).The percentage of plasma cells detected by bone marrow cell morphology was(25.72±8.33)%,and the percentage of plasma cells detected by multiparameter flow cytometry was(11.48±3.29)%,and the difference was statistically significant(P<0.05).In groups A,B,and C,the sensitivity of multiparameter flow cytometry to detect the proportion of plasma cells were 80.00%,50.00%,and 0.00%,respectively,respectively,and the sensitivity of bone marrow cell morphology to detect the proportion of plasma cells were 100.00%,100.00%,0.00%,respectively.There was no significant difference in the sensitivity of the two methods in the new-onset group and the follow-up group(P=0.833,0.825).There were 12 positive cases of cKappa/cLambda in group C detected by multiparameter flow cytometry.Conclusion The combined application of bone marrow cell morphology and multiparameter flow cytometry can improve the detection rate of abnormal plasma cells in MM and reduce the missed diagnosis rate.