摘要
目的探讨骨髓涂片、骨髓免疫组织化学检查、流式细胞术、荧光原位杂交(FISH)以及细胞遗传学检测在初诊多发性骨髓瘤中的应用价值。方法收集2018年9月至2019年8月于天津金域医学检验实验室初诊的多发性骨髓瘤患者280例,均按照常规方法进行骨髓穿刺,并进行骨髓涂片、骨髓免疫组织化学检查、流式细胞术免疫分型、FISH、细胞遗传学检测,比较各检测方法的结果。结果280例患者中,骨髓免疫组织化学检查的中位浆细胞比例高于骨髓涂片(20例,0.675比0.300)及流式细胞术(47例,0.650比0.147),差异均有统计学意义(Z=-3.883,P<0.01;Z=-5.947,P<0.01)。流式细胞术检测CD38、CD138、κ、λ、CD56、CD19的阳性率分别为100.0%(280/280)、100.0%(280/280)、57.5%(161/280)、42.5%(119/280)、62.1%(174/280)、19.3%(54/280);骨髓免疫组织化学检查中CD38、CD138、κ、λ、CD56的阳性率分别为98.9%(277/280)、98.2%(275/280)、57.5%(161/280)、42.5%(119/280)、62.1%(174/280);两种检测方法对相同检测指标的检测符合率比较,差异均无统计学意义(均P>0.05)。行FISH检测的患者基因异常检出率为69.9%(93/133),其中直接荧光原位杂交(D-FISH)异常检出率为42.9%(57/133),CD138磁珠分选系统(MACS)-FISH异常检出率为82.7%(110/133)。行G显带检测的患者异常染色体核型检出率为38.5%(85/221)。FSIH,尤其是MACS-FISH,细胞遗传学异常检出率高于G显带检测,差异有统计学意义(χ^(2)=65.697,P<0.05)。结论骨髓涂片、骨髓免疫组织化学检查、流式细胞术、FISH(尤其是MACS-FISH)、细胞遗传学等多种检查方法综合应用更有助于多发性骨髓瘤的诊断,并可能对预后判定有一定的意义。
Objective To investigate the application values of bone marrow morphology,bone marrow immunohistochemistry,flow cytometry,fluorescence in situ hybridization(FISH)and cytogenetic testing in newly diagnosed multiple myeloma.Methods A total of 280 patients with multiple myeloma who were newly diagnosed in Tianjin KingMed Diagnosis Center from September 2018 to August 2019 were collected.The bone marrow biopsy was carried out according to the routine method,and bone marrow morphology,bone marrow immunohistochemistry,flow cytometry immunophenotyping,FISH and cytogenetic testing were performed.The detection results of each method were compared.Results In 280 patients,the bone marrow immunohistochemistry results showed that the median ratio of plasma cells was higher than those of bone marrow morphology(20 cases,0.675 vs.0.300)and flow cytometry(47 cases,0.650 vs.0.147),and the differences were statistically significant(Z=-3.883,P<0.01;Z=-5.947,P<0.01).Flow cytometry results showed that the positive rates of CD38,CD138,κ,λ,CD56 and CD19 were 100.0%(280/280),100.0%(280/280),57.5%(161/280),42.5%(119/280),62.1%(174/280)and 19.3%(54/280);bone marrow immunohistochemistry results showed that the positive rates of CD38,CD138,κ,λand CD56 were 98.9%(277/280),98.2%(275/280),57.5%(161/280),42.5%(119/280)and 62.1%(174/280);there was no statistical difference between the two detection methods in the detection coincidence rate of the same detection index(all P>0.05).Among patients who underwent FISH detection,the detection rate of gene abnormalities was 69.9%(93/133);the detection rate of abnormalities by direct fluorescence in situ hybridization(D-FISH)was 42.9%(57/133);the detection rate of abnormalities by CD138 immunomagnetic sorting myeloma cells(MACS)-FISH was 82.7%(110/133).Among patients who underwent G-band karyotyping,the detection rate of abnormal karyotype was 38.5%(85/221).FSIH,especially MACS-FISH,had a higher detection rate of cytogenetic abnormalities than G-band karyotyping,and the difference was statistically si
作者
常娟
杨小雨
张娜
陈辉树
李焱
贾振薇
王立荣
郑娟娟
周剑峰
楚玉兰
韩伟宁
王超
Chang Juan;Yang Xiaoyu;Zhang Na;Chen Huishu;Li Yan;Jia Zhenwei;Wang Lirong;Zheng Juanjuan;Zhou Jianfeng;Chu Yulan;Han Weining;Wang Chao(Hematopathology Center,Tianjin KingMed Diagnosis Center,Tianjin 300392,China;Department of Hematology,the First Hospital of Handan in Hebei Province,Handan 056002,China)
出处
《白血病．淋巴瘤》
CAS
2021年第6期344-348,共5页
Journal of Leukemia & Lymphoma
关键词
多发性骨髓瘤
骨髓检查
涂片
免疫组织化学
流式细胞术
原位杂交
荧光
细胞遗传学
Multiple myeloma
Bone marrow examination
Smear
Immunohistochemistry
Flow cytometry
In situ hybridization,fluorescence
Cytogenetics
