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目的研究多发性骨髓瘤(multiple myeloma,MM)合并胸腔积液的临床特点。方法回顾分析北京积水潭医院2004-2015年收治的骨髓瘤性胸腔积液患者的临床资料。结果我院近11年资料完整的胸腔积液患者共3 590例,其中MM患者348例,MM合并胸腔积液者34例,占MM患者的9.8%。仅2例骨髓瘤性胸腔积液(myelomatous pleural effusion,MPE),此2例MPE均经流式细胞学检查确诊。1例为女性,首发临床表现为胸腔积液,诊断为多发性骨髓瘤不分泌型Ⅲ期A型(DS分期),不分泌性Ⅰ期(ISS分期)。1例为男性,诊断为多发性骨髓瘤Ig A-κⅢ期A(DS分期),Ⅱ期(ISS分期)。结论 MPE的检出率很低。MPE为黄色渗出液,性状及理化指标缺乏特征。受骨髓瘤细胞浸润的胸壁可见多个黄色结节,结节有分叶且血供丰富。胸腔积液常规细胞病理学检查敏感性低,流式细胞学检查技术对于MPE的检测具有敏感性高、特异性高的优点,建议推广应用于胸腔积液的检查。
Objective To study the clinical features of multiple myeloma (MM) combined with pleural effusion. Methods The clinical data of patients with myeloma pleural effusion admitted to Beijing Jishuitan Hospital from 2004 to 2015 were retrospectively analyzed. Results There were 3 590 cases of pleural effusion in our hospital in the past 11 years, including 348 MM patients, 34 MM patients with pleural effusion, accounting for 9.8% of MM patients. Only 2 cases of myelomatous pleural effusion (MPE), 2 cases of MPE were confirmed by flow cytometry. One patient was female. The first clinical manifestation was pleural effusion, diagnosed as multiple myeloma, non-secreting type III A (DS stage), non-secreting stage I (ISS stage). One patient was male and was diagnosed with multiple stage myeloma Ig A-kappa A (DS stage) and stage II (ISS stage). Conclusion The detection rate of MPE is very low. MPE is yellow exudate, lack of characteristics and physical and chemical indicators. By the myeloma cell infiltration of the chest wall visible multiple yellow nodules, nodules have lobulated and rich in blood supply. Pleural effusion routine cytopathological examination of low sensitivity, flow cytometry for the detection of MPE with high sensitivity and specificity of the advantages of recommended to promote the examination of pleural effusion.