Comprehensive Application Of Laboratory Tests In The Diagnosis And Rreatment Of Multiple Myeloma

ObjectiveOverall study different stages,different types of patients with multiple myeloma laboratory markers,a deeper analysis from different angles of different laboratory indexes and comparing different method in the diagnosis of patients with multiple myeloma and correlation studies,to explore its comprehensive application in early diagnosis,therapeutic effect monitoring and prognosis judgement of the patients with multiple myeloma.MethodsCollect the 206 cases of multiple myeloma patients with clinical stage（Durie-Salmon staging criteria）from first affiliated hospital of Guangzhou TCM university in January 2014 to December 2016;detecting bone marrow cytology,quantitative immunoglobulins,β2-microglobulin,creatinine,urea nitrogen,serum calcium,albumin,serum protein electrophoresis,immunofixation electrophoresis（including agarose gel electrophoresis and capillary electrophoresis）,urine Bence Jones protein,flow phenotype;Statistical analysis was carried out on the detection index,to explore comprehensive application of these indicators in different stages,different types of multiple myeloma patients.ResultsAccording to the diagnostic criteria in the"blood disease diagnosis and treatment standards",206 cases of multiple myeloma patients with Durie-Salmon clinical staging,I of 81 cases,II 50 cases,stage III 75 cases.According to IFE results,IgAκ33 cases,IgAλ27 cases,IgGκtype 95cases,IgGλ20 cases,κmonoclonal 7 cases,λmonoclonal 24 cases.In 31cases of light chain MM patients,2 patients biclonal type required for review by agarose gel electrophoresis,and the remaining 29 cases of light chain can be detected directly by capillary electrophoresis.IgA and IgG were detected directly by capillary electrophoresis,does not need to review the agarose gel electrophoresis.Serum protein electrophoresis of M protein was detected in 176 cases,the positive rate is 90.29%.IgA type 57 cases,IgG type 110cases,light chain type 9 cases,the positive rate of were M protein 95.00%,95.65%,29.03%.Albumin,IgG,IgA,IgM,CREA,UREA of IgA type compared with control group,P<0.05,the difference was significant,β₂ microglobulin compared with control group,P>0.05,the difference was not significant;IgG,IgA,IgM,CREA,UREA of IgG-type compared with control group,P<0.05,the difference was significant,albumin,β₂ microglobulin,CRP compared with control group,P>0.05,the difference was not significant;Albumin,β₂-microglobulin,IgG,IgA,IgM,CREA,UREA of Light chain compared with control group,P<0.05,the difference was significant,CRP compared with control group,P>0.05,the difference was not statistically significant.The M protein of Light chain type compared with the IgA type,P=0.000,compared with the IgG type,P=0.000,the difference was significant;Theβ₂microglobulin of Light chain compared with the IgA type,P=0.001,compared with the IgG type,P=0.021,the difference was significant;IgG of the IgG type compared with the IgA type,P=0.000,compared with the Light chain type,P=0.000,the difference was significant;Ig A of the IgA type compared with the IgG type,P=0.000,compared with the Light chain type,P=0.000,the difference was significant;CREA of the Light chain type compared with the IgA type,P=0.000,compared with the IgG type,P=0.000,the difference was significant;UREA of the Light chain type compared with the IgA type,P=0.000,compared with the IgG type,P=0.001,the difference was significant.M protein of stageⅢcompared with stage I,P=0.000,compared with stageⅡ,P=0.043,the difference was significant;β₂ microglobulin of stageⅢcompared with stage I,P=0.000,compared with stageⅡ,P=0.000,the difference was significant;CREA of stageⅢcompared with stage I,P=0.000,compared with stageⅡ,P=0.000;the difference was statistically significant;UREA of stageⅢcompared with stage I,P=0.000,compared with stageⅡ,P=0.005,the difference was significant.The correlation coefficient of M protein andβ₂ microglobulin was 0.138,P=0.048,the difference was significant,of M protein and CREA was-0.145,P=0.038,the difference was significant;The correlation coefficient ofβ₂microglobulin and CREA was 0.513,P=0.000,the difference was statistically significant,ofβ₂ microglobulin and UREA was 0.302,P=0.000,the difference was significant;The correlation coefficient of CREA and UREA was 0.443,P=0.000,the difference was significant.With CD45/SSC gating,various types of multiple myeloma cells in the presence of a restricted expression of the light chain,antigen CD19,CD38,CD45,CD56,CD138 expression positive rate was 1.45%,100%,1.94%,97.09%and100%.In bone marrow smear examination of 206 patients,bone marrow hyperplasia to active was 192 cases（93.20%）,myeloproliferative reduce was 14 cases（6.80%）;myeloma cells>10%was 179 cases（86.89%）,<10%was 27 cases（13.11%）,19 cases of myeloma cell morphology changes significantly,typical clinical manifestations,8 cases of suspected in peripheral blood lead reduction ratio.The morphology of Myeloma cell mainly seeing loose chromatin,most obvious nucleolus,visible dual-core,multi-core,multi-core huge,flame-like cells,loose chromatin,morphological changes significantly.There are five cases of myeloma cells in blood film classificationcells of 206 cases,but the proportion was<10%.There are 13 cases of urinary Bence Jones protein test positive,the positive rate is 6.31%.Conclusion1.Serum protein electrophoresis is a common method of early screening for clinical staging and treatment for multiple myeloma,but for the patients with a high clinical suspicion of multiple myeloma,it must combine with other indicators to judge.2.Immune fixed automatic capillary electrophoreis genotyping method is a conventional method in diagnosis M protein of multiple myeloma,but it must combine with anti-IgD,IgE serum by agarose gel electrophoresis when as a screening method for light chain and a rare type of MM patients.3.The quantitative of Immune globulin is an important detection method laboratory diagnosis of in patients with multiple myeloma tumor,it must pay special attention to the patients whose quantitative of IgG,IgA and IgM are lower,it must be combined with anti-IgD,IgE serum for further identification to prevent misdiagnosis.4.The heated precipitation reaction in urine Bence Jones proteins have been unable to meet the demand for clinical diagnosis of multiple myeloma,which clinical value is not high.5.Beta 2 microglobulin and CREA,UREA combined application in renal damage for patients with multiple myeloma,these indicators are guiding value for efficacy and their clinical staging,to determine the disease progression and the severity;Light-chain multiple myeloma have a more severe renal impairment than other types of multiple myeloma.6.Bone marrow smear cytology have played an important role in the diagnosis of multiple myeloma,but it needs further study for comparative morphology between different types of multiple myeloma;flow immune genotyping provides a very objective basis for the diagnosis and assessment of treatment of multiple myeloma.