流式浆细胞及骨髓涂片检测在多发性骨髓瘤中的诊断价值及其与临床分期的相关性

目的探讨流式细胞术检测浆细胞比例及骨髓涂片检测在多发性骨髓瘤患者中的诊断价值及其与临床分期的相关性。方法选择2013年1月至2018年12月临床疑似多发性骨髓瘤患者120例,采集所有患者的骨髓液和骨髓组织样本,分别对其进行流式细胞术检测、骨髓涂片及活检病理检查,统计流式细胞术检测及骨髓涂片检测浆细胞的诊断与骨髓活检结果的一致率,并分析流式细胞术及骨髓涂片检测结果在不同临床分期患者间的差异。结果120例入选患者确诊为多发性骨髓瘤患者113例,阴性患者7例。骨髓涂片检测阳性率为89.17%,流式细胞术检测阳性率为75.83%,经Kappa一致性检验,骨髓涂片检测与活检结果有良好的一致性,而流式细胞术检查与活检结果一致性稍差。在不同临床分期比较中,I期患者流式浆细胞检测阳性率高于骨髓涂片,而在II期、III期两种检测结果差异无统计学意义。结论流式细胞术及骨髓涂片检测浆细胞均能用于多发性骨髓瘤患者的诊断,且流式细胞术检测与骨髓活检的一致率更高,对于早期患者诊断敏感度更高,值得临床推广。

Objective To investigate the diagnostic value of flow cytometry and bone marrow smear in patients with multiple myeloma and its relationship with clinical stage.Methods A total of 120 patients with clinically suspected multiple myeloma who were admitted to our hospital from January 2013 to December 2018 were enrolled in this study.All patients were collected bone marrow fluid and bone marrow tissue samples for flow cytometry.Bone marrow smear and biopsy pathological examination were conducted.The statistical analysis of the consistency of flow cytometry and bone marrow smear detection of plasma cell diagnosis and bone marrow biopsy results was conducted.The differences between flow cytometry and bone marrow smear test results in different clinical stages were analyzed.Results Of the 120 patients enrolled,113 were diagnosed as multiple myeloma and 7 were negative.The positive rate of bone marrow smear test was 89.17%,and the positive rate of flow cytometry test was 75.83%.The Kappa consistency test showed good agreement between bone marrow smear test and biopsy results.Flow cytometry and biopsy results were less consistent.In the comparison of different clinical stages,the positive rate of flow cytometry in stage I patients was higher than that in bone marrow smears,but there was no significant difference between the two methods in stage II and stage III.Conclusion Flow cytometry and bone marrow smear detection of plasma cells can be used for the diagnosis of multiple myeloma patients.The consistency of flow cytometry and bone marrow biopsy is higher,and the sensitivity of early diagnosis is higher.It is worthy of clinical recommendation.