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目的了解M蛋白的分型及临床意义,提高认识和诊断水平。方法通过对1998年1月至2005年12月上海交通大学医学院附属新华医院血液科诊治及少量外院送检标本M蛋白阳性者共639例结合临床对年龄、性别和疾病分布,以及多发性骨髓瘤(MM)与意义未明或继发性单克隆丙种球蛋白(MGUS)的特点进行分析。结果639例M蛋白血症中IgG型409例(64.0%)、IgA型80例(12.5%)、IgM型79例(12.4%)、IgD型4例(0.6%)、轻链型27例(4.2%,其中κ9例、λ18例)、双克隆型27例(4.2%)、单克隆型13例(2.0%)。该组患者病种分布,MM115例(18.0%)、华氏巨球蛋白血症(WM)13例(2.0%)、肾原发性淀粉样变性(AL)1例、非霍奇金淋巴瘤(NHL)19例(3.0%)、慢性淋巴细胞白血病(CLL)5例(0.8%)、MGUS473例(74.0%)、寡克隆13例(2.0%)。结论M蛋白血症是一种亚临床现象,主要见于MM及淋巴细胞增殖性疾病,意义未明或继发者检出率有增加趋势。
Objective To understand the classification and clinical significance of M protein and to improve the level of understanding and diagnosis. Methods From January 1998 to December 2005, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Department of Hematology and a small amount of M hospital specimens were positive for a total of 639 cases of clinical distribution of age, gender and disease, and multiple bone marrow Tumors (MM) were analyzed for features of unknown or secondary monoclonal gammoglobin (MGUS). Results There were 409 cases of IgG (64.0%), 80 cases (12.5%) of IgA, 79 cases (12.4%) of IgM, 4 cases of IgD (0.6%) and 27 cases of light chain 4.2%, among them, κ9 cases and λ18 cases), 27 cases (4.2%) were bi-clonal and 13 cases (2.0%) were monoclonal. In this group of patients, the distribution of disease types was MM115 (18.0%), Fahrenheit macular leukemia (WM) in 13 cases (2.0%), renal primary amyloidosis (AL) in 1 and non-Hodgkin’s lymphoma NHL), 19 cases (3.0%), 5 cases (0.8%) of chronic lymphocytic leukemia (CLL), 474 cases of MGUS (74.0%) and 13 cases (2.0%) of oligoclonal. Conclusions M-type leukemia is a subclinical phenomenon mainly found in MM and lymphoproliferative diseases. There is an increasing trend in the detection of unknown or secondary cancers.