CAJ | 학술논문

目的：通过对1256例 M 蛋白阳性病例的分析，提高对这类疾病的认识，减少误诊和漏诊。方法收集广州军区武汉总医院2012年6月至2013年6月1256例M 蛋白阳性的初诊患者相关资料，分析病例的病种分布与年龄、性别的关系，比较多发性骨髓瘤（MM）与非MM的首发症状，分析MM 的M蛋白类型和M 蛋白水平。结果1256例M蛋白阳性病例中，M M 1215例（96．7％），良性或继发性单克隆免疫球蛋白疾病41例（3．3％）。患者男女比例1．34∶1，平均年龄63．1岁，50岁以下初诊患者306例（25．2％）。M M 首发症状以腰痛、骨痛为主，非M M 以发热、贫血、乏力为主，二者差异有统计学意义（ P＜0．05）。M M 患者中 IgG 型742例（61．2％），IgA型280例（23．0％），IgM型81例（6．7％），IgD型36例（3．6％），轻链型53例（4．4％），双克隆M 蛋白型12例（1．0％），非分泌型1例（0．1％），其中IgG、A、M、D型相应的免疫球蛋白显著增高。结论 M 蛋白阳性主要见于M M ，男性多于女性，且近两年发病更趋于年轻化，以IgG型为主。当患者出现腰痛、骨痛，且免疫球蛋白异常增高或降低时，应及时检查血清蛋白电泳和免疫固定电泳，必要时进行骨髓检查。
목적：통과대1256례 M 단백양성병례적분석，제고대저류질병적인식，감소오진화루진。방법수집엄주군구무한총의원2012년6월지2013년6월1256례M 단백양성적초진환자상관자료，분석병례적병충분포여년령、성별적관계，비교다발성골수류（MM）여비MM적수발증상，분석MM 적M단백류형화M 단백수평。결과1256례M단백양성병례중，M M 1215례（96．7％），량성혹계발성단극륭면역구단백질병41례（3．3％）。환자남녀비례1．34∶1，평균년령63．1세，50세이하초진환자306례（25．2％）。M M 수발증상이요통、골통위주，비M M 이발열、빈혈、핍력위주，이자차이유통계학의의（ P＜0．05）。M M 환자중 IgG 형742례（61．2％），IgA형280례（23．0％），IgM형81례（6．7％），IgD형36례（3．6％），경련형53례（4．4％），쌍극륭M 단백형12례（1．0％），비분비형1례（0．1％），기중IgG、A、M、D형상응적면역구단백현저증고。결론 M 단백양성주요견우M M ，남성다우녀성，차근량년발병경추우년경화，이IgG형위주。당환자출현요통、골통，차면역구단백이상증고혹강저시，응급시검사혈청단백전영화면역고정전영，필요시진행골수검사。
Objective To improve the understanding of M protein positive disease ,in order to reduce misdiag-nosis and missed diagnosis .Methods Clinical data of 1 256 patients with positive with M protein were analyzed to i-dentify the relationship between diseases distribution and age ,gender of patients ,the primary symptoms of multiple myeloma(MM) and non-MM ,and the types and levels of M protein in patients with MM .Results In all 1 256 cases positive with M protein ,there were 1 215 cases of MM (96 .7% ) and 41 cases of benign or secondary monoclonal gammopathies (3 .3% ) .The male female ratio of patients was 1 .34∶1 .The average age of patients was 63 .1 years old ,and 306 cases (25 .2% ) were less than 50 years old .There was significant difference between MM and non-MM in primary symptoms(P<0 .05) .In patients with MM ,the mainly primary symptoms were lumbago and bone pain , but in patients with non-MM ,the mainly primary symptoms were fever ,weight loss and fatigue .In patients with MM ,742 cases (61 .2% ) were IgG type ,280 cases (23 .0% ) were IgA type ,81 cases (6 .7% ) were IgM type ,36 ca-ses (3 .6% ) were IgD type ,53 cases (4 .4% ) were light chain type ,12 cases (1 .0% ) were double-clonal type and 1 case (0 .1% ) was non-secretion type .The levels of immunoglobulin corresponding to M protein in IgG ,A ,M and D type were significantly higher .Conclusion Positive of M protein could be discovered mainly in patients with MM . The dominant type of MM could be IgG type ,the incidence might be younger in recent years ,and the incidence rate in males cold be higher than females .Examination of serum protein electrophoresis and immunofixation electrophoresis should be performed promptly ,when patients are with lumbago and bone pain ,and the levels of immunoglobulin are abnormally increased or decreased .Bone marrow examination should also be performed ,when it is necessary .