流式细胞术免疫表型分析在多发性骨髓瘤诊疗中的临床应用价值

The Clinical Application Value of Immunophenotype Analysis by Flow Cytometry in the Diagnosis and Treatment of Multiple Myeloma

目的:探讨流式细胞术(flow cytometry,FCM)免疫表型分析在多发性骨髓瘤(MM)诊疗中的临床意义。方法:选取2019年1月至2023年6月宁夏医科大学总医院血液内科收治的117例初发确诊MM患者,采用流式细胞仪多色荧光标记抗体进行免疫表型分析检测,并同时收集患者骨髓细胞形态学、免疫固定电泳(IFE)、免疫球蛋白定量检测结果分析。结果:117例MM患者经CD45/SSC与CD45/CD38点图设门分析,CD45阴性或弱阳、CD38强阳且SSC较有核红细胞大的分布区域可见异常细胞群体,约占有核细胞比例为0.1%~91.5%,117例均强表达CD38、111例表达CD138、78例表达CD56、67例表达CD229、48例表达CD27、44例表达CD200、40例表达CD117、30例表达CD269、25例表达CD28、19例表达CD20、9例表达CD81、7例表达CD13、4例表达CD19,阳性表达率分别为100%、94.87%、66.67%、57.26%、41.03%、37.61%、34.19%、25.64%、21.37%、16.24%、7.69%、5.98%、3.42%,117例全部均为限制性表达胞质轻链(100%),其中64例限制性表达cKappa轻链(54.70%)、53例限制性表达cLambda轻链(45.30%)。骨髓细胞形态学检查111例镜下形态分类可见骨髓瘤细胞(94.87%),血清IFE检测114例检出M蛋白,M蛋白检出率为97.44%。结论:FCM免疫表型分型能准确、快速、客观的鉴别出良恶性浆细胞,揭示胞质轻链克隆性表达情况及骨髓瘤细胞CD分子的表达特征,为MM早期诊断、分型及预后评估和治疗提供客观依据,具有较好的临床应用价值。

Objective:To explore the clinical significance of flow cytometry(FCM)immunophenotype analysis in the diagnosis and treatment of multiple myeloma(MM).Methods:A total of 117 newly diagnosed MM patients admitted to the Hematology Department of Ningxia Medical University General Hospital from January 2019 to June 2023 were selected for immunophenotypic analysis using flow cytometry with polychromatic fluorescent labeled antibodies.At the same time,bone marrow cell morphology,immunofixation electrophoresis(IFE),and quantitative immunoglobulin detection results were collected and analyzed.Results:117 MM patients underwent gate analysis using CD45/SSC and CD45/CD38 dot maps.Abnormal cell populations were observed in areas with CD45 negative or weakly positive,CD38 strongly positive,and SSC larger than those with nuclear red blood cells,accounting for approximately 0.1%to 91.5%of nuclear cells.CD38 was strongly expressed in all 117 cases,CD138 in 111 cases,CD56 in 78 cases,CD229 in 67 cases,CD27 in 48 cases,CD200 in 44 cases,CD117 in 40 cases,CD269 in 30 cases,CD28 in 25 cases,CD20 in 19 cases,CD81 in 9 cases,CD13 in 7 cases,and CD19 in 4 cases and the positive expression rates were 100%,94.87%,66.67%,57.26%,41.03%,37.61%,34.19%,25.64%,21.37%,16.24%,7.69%,5.98%,and 3.42%,respectively.All 117 cases were restrictedly expressed with cytoplasmic light chains(100%),of which 64 cases were restrictedly expressed with cKappa light chains(54.70%)and 53 cases with cLambda light chains(45.30%).Morphological examination of bone marrow cells revealed myeloma cells in 111 cases(94.87%)under microscope,and M protein was detected in 114 cases using IFE,with a detection rate of 97.44%.Conclusions:FCM immunophenotyping can accurately,quickly,and objectively distinguish between benign and malignant plasma cells,reveal the clonal expression of cytoplasmic light chain and the expression characteristics of CD molecules in myeloma cells,and provide objective basis for the early diagnosis,classification,prognosis evaluation,and treatment of MM.It has good clinical application value.