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本文报告1例罕见的μ重链型“不分泌型”骨髓瘤,并就发病的机理加以讨论。患者,女性,67岁。因贫血、腰背部疼痛入院。体检:脊柱因疼痛而致活动受限。肝、脾、淋巴结不肿大。X线照片示广泛骨质脱钙、颅骨与胸椎4、5溶骨性损害及右侧肱骨骨干骨折。化验:血红蛋白10.0g,白细胞4,100,分类未见异常,血小板35万。血沉45mm/h。血清钙3.2mmol/l。尿素氮、肌酐正常。总蛋白7.4g。骨髓检查:浆细胞30%,浆细胞酸性磷酸酶阳性率100%,积分增高(230),糖原阴性。血清蛋白电泳无M带。免疫球蛋白偏低:IgG6.4g/l,IgA0.75g/l,IgM0.03g/l。血清与浓缩尿免疫电泳抗γ、α、μ与抗κ、λ均无异常沉淀弧。血液:
This article reports a rare case of a murine myeloma with a heavy chain type of “unsecreted” and discusses the pathogenesis mechanism. Patient, female, 67 years old. He was hospitalized for anaemia and low back pain. Physical examination: The spine is limited in activity due to pain. Liver, spleen, lymph nodes are not swollen. X-ray photographs show extensive bone decalcification, osteolytic lesions of the skull and thoracic vertebrae 4, 5, and a fracture of the right tibia and fibula. Laboratory tests: Hemoglobin 10.0g, white blood cells 4,100, no abnormalities in classification, platelets 350,000. ESR 45mm/h. Serum calcium 3.2mmol/l. Urea nitrogen and creatinine are normal. Total protein 7.4g. Bone marrow examination: plasma cells 30%, plasma cell acid phosphatase positive rate of 100%, integral increased (230), glycogen was negative. Serum protein electrophoresis without M band. Immunoglobulins were low: IgG 6.4 g/l, IgA 0.75 g/l, IgM 0.03 g/l. Serum and concentrated urine immunoelectrophoretic anti-γ, α, μ and anti-κ, λ were no abnormal precipitation arc. blood: