【摘要】：背景多發(fā)性骨髓瘤(Multiple myeloma, MM)是以B細(xì)胞起源,骨髓中惡性漿細(xì)胞(瘤細(xì)胞)異常增生和聚集為特征的一種衰竭性、難以治愈的惡性腫瘤,并伴有單克隆免疫球蛋白或其成分(M蛋白)增多。由于在疾病早期,其臨床表現(xiàn)無(wú)特異性,極易出現(xiàn)誤診和漏診。本試驗(yàn)通過(guò)免疫細(xì)胞化學(xué)、流式細(xì)胞術(shù)對(duì)傳統(tǒng)骨髓細(xì)胞形態(tài)學(xué)診斷的50例MM進(jìn)行細(xì)胞免疫表型分析,并比較三種檢測(cè)方法之間的差異,以期為MM的早期診斷及療效判斷提供更可靠的檢測(cè)方法。目的探討骨髓細(xì)胞形態(tài)學(xué)、免疫細(xì)胞化學(xué)和流式細(xì)胞術(shù)在MM檢測(cè)中的應(yīng)用價(jià)值。方法1采用瑞氏染色,對(duì)50例MM患者骨髓標(biāo)本進(jìn)行形態(tài)學(xué)觀察；2分別采用流式細(xì)胞術(shù)、免疫細(xì)胞化學(xué)方法檢測(cè)50例MM患者骨髓瘤細(xì)胞的免疫表型,分析其表達(dá)率；3比較三種檢測(cè)技術(shù)在MM檢測(cè)中的應(yīng)用價(jià)值。結(jié)果1形態(tài)學(xué)檢測(cè)結(jié)果：50例患者骨髓細(xì)胞形態(tài)學(xué)結(jié)果主要為骨髓瘤細(xì)胞增生,并伴有質(zhì)的改變。形態(tài)學(xué)檢查骨髓瘤細(xì)胞比例為6.0%-95.0%。2免疫細(xì)胞化學(xué)結(jié)果：50例MM患者CD138陽(yáng)性表達(dá)率98.0%(49/50), Kappa陽(yáng)性14例,Lambda陽(yáng)性12例。3流式細(xì)胞術(shù)結(jié)果：對(duì)骨髓瘤細(xì)胞抗原CD38、CD138、CD19、CD56、CD45、 cKappa、cLambda進(jìn)行分析,結(jié)果發(fā)現(xiàn)：50例MM中CD138、CD38陽(yáng)性表達(dá)率均為100.00%(50/50),其他抗原表達(dá)陽(yáng)性率由高到低分別為：CD5670.0%(35/50), CD1910.0%(5/50), CD454.0%(2/50)。Kappa輕鏈型占28.0%(14/50), Lambda輕鏈型占24.0%(12/50)。450例MM患者,形態(tài)學(xué)檢測(cè)骨髓瘤細(xì)胞中位數(shù)比例為45.00%(6.00%-95.00%),免疫細(xì)胞化學(xué)檢測(cè)中位數(shù)比例為37.25%(9.00%～88.00%),流式細(xì)胞術(shù)檢測(cè)中位數(shù)比例為28.16%(4.07-87.42%)。550例MM患者免疫細(xì)胞化學(xué)結(jié)果陽(yáng)性38例,陽(yáng)性率為76.0%(38/50)。流式細(xì)胞術(shù)結(jié)果陽(yáng)性37例,陽(yáng)性率為74.0% (37/50),兩種方法差異無(wú)統(tǒng)計(jì)學(xué)意義(X2=0.049,P0.05)。結(jié)論1免疫細(xì)胞化學(xué)與流式細(xì)胞術(shù)對(duì)MM確診都有檢測(cè)意義。2骨髓細(xì)胞形態(tài)學(xué)、免疫細(xì)胞化學(xué)及流式細(xì)胞術(shù)三種檢測(cè)技術(shù)相結(jié)合,更有助于MM的診斷及鑒別診斷。
[Abstract]:Background multiple myeloma (Multiple myeloma, MM) is a failing and intractable malignant tumor characterized by the origin of B cells and the abnormal proliferation and aggregation of malignant plasma cells (tumor cells) in bone marrow. It was accompanied by an increase in monoclonal immunoglobulin or its component (M protein). Due to the lack of specificity in the early stage of the disease, misdiagnosis and missed diagnosis are easy to occur. The immunophenotype of 50 cases of MM diagnosed by traditional bone marrow cell morphology was analyzed by immunocytochemistry and flow cytometry, and the differences among the three methods were compared. In order to provide a more reliable detection method for early diagnosis and curative effect judgment of MM. Objective to investigate the value of bone marrow cell morphology, immunocytochemistry and flow cytometry in the detection of MM. Methods 1Morphology of bone marrow specimens from 50 patients with MM were observed by Rayleigh staining, 2Immunophenotypes of myeloma cells from 50 patients with MM were detected by flow cytometry and immunocytochemistry, and the expression rate of myeloma cells was analyzed. 3 compare the application value of three detection techniques in MM detection. Results 1Morphologic examination: the morphologic results of bone marrow cells in 50 patients were mainly myeloma cell proliferation, accompanied by qualitative changes. The proportion of myeloma cells was 6.0- 95.0.2 immunocytochemical results: the positive expression rate of CD138 was 98.0% (49 / 50), Kappa in 14 cases, Lambda positive in 12 cases) in 50 patients with MM. The results showed that the positive rate of CD138,CD38 expression in 50 cases of MM was 100.00% (50 / 50). The positive rates of other antigens were: CD5670.0% (35 / 50), CD1910.0% (5 / 50), CD454.0% (2 / 50). Kappa light chain type) 28.0% (14 / 50), Lambda light chain type 24.0% (12 / 50). The median percentage of myeloma cells, immunocytochemistry and flow cytometry were 45.00% (6.00-95.00%), 37.25% (9.0088.00%) and 28.16% (4.07-87.42%), respectively. The positive rate of immunocytochemistry was 76.0% (38 / 50) in 550 patients with MM. The positive rate of flow cytometry was 74.0% (37 / 50), and there was no significant difference between the two methods (X2, 0.049, P0.05). Conclusion (1) Immunocytochemistry and flow cytometry are important for the diagnosis of MM. (2) the combination of bone marrow cell morphology, immunocytochemistry and flow cytometry is helpful to the diagnosis and differential diagnosis of MM.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R733.3

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