多发性骨髓瘤合并2型糖尿病1例幷文献复习

多发性骨髓瘤(MM)是一种恶性浆细胞疾病,主要发病机制为单克隆浆细胞在骨髓中恶性增生并广泛浸润,常常伴有血或尿中大量单克隆免疫球蛋白或(和)轻链的分泌,使正常多克隆浆细胞增生和多克隆免疫球蛋白分泌受到抑制,从而引起广泛骨质破坏、反复感染、贫血、周围神经病变、肾功能不全等临床症状。2型糖尿病也可引起肾功能不全、反复感染、周围神经病变。通过对1例以初诊多发性骨髓瘤合并2型糖尿病患者的临床表现、检查结果、治疗方案进行分析,提出诊断的要点及治疗方案的完善,以减少误诊、漏诊的发生,提高初诊多发性骨髓瘤的诊断及治疗效果。     

一例白癜风合并多发性骨髓瘤病例报道

患者女,66岁。既往有白癜风病史,查体:四肢、胸背部可见大片色素脱失斑,呈瓷白色,边界清楚。免疫固定电泳:IgG、K阳性。血清蛋白电泳:有M蛋白条带。骨髓穿刺:异常增生的浆细胞占有核细胞的39%,骨髓活检及免疫分型符合浆细胞肿瘤表型。诊断:白癜风合并多发性骨髓瘤。     

1231例骨髓细胞形态学的诊断分析

目的:探讨骨髓细胞形态学改变及其对临床的诊断意义.方法:回顾性分析1 231例患者的骨髓检查,并对其细胞化学染色结果进行分析.结果:按细胞形态及细胞化学染色可将1 231例的患者分为,急性非淋巴细胞性白血病占11.9％,急性淋巴细胞性白血病占6.7％,溶血性贫血占3.3％,缺铁性贫血占13.0％,感染占11.2％等.结论:细胞形态学改变是诊断血液病学的重要指标,骨髓细胞学检查对确诊血液病是必要的.     

多发性骨髓瘤误诊分析

目的探讨多发性骨髓瘤(MM)的临床特征方法回顾性分析16例MM患者临床资料。结果16例病人均被误诊,误诊时间1到32个月,平均误诊时间13个月。最易被误诊为骨科疾病。结论对中年以上的反复感染发热、骨痛、贫血等都应考虑MM的可能,需进一步进行检查。     

多发性骨髓瘤误诊分析

目的探讨多发性骨髓瘤(MM)的临床特征方法回顾性分析16例MM患者临床资料.结果 16例病人均被误诊,误诊时间1到32个月,平均误诊时间13个月.最易被误诊为骨科疾病.结论对中年以上的反复感染发热、骨痛、贫血等都应考虑MM的可能,需进一步进行检查.     

硼替佐米联合化疗治疗复发难治性多发性骨髓瘤的临床应用研究

观察硼替佐米联合化疗治疗复发难治性多发性骨髓瘤的临床疗效及不良反应;16例复发难治性MM患者给予硼替佐米1．3mg／m^2／次d1,4,8,11,表柔比星10rag,d1-4,地塞米松40rag,d1-4,20rag,d8-11随后停药10d（第12—21天）,3周为1个疗程。两次给药至少间隔72h。疗效判定主要采用EBMT标准,并按NCICTCAE标准判断不良反应;16例患者中NR2例（12．5％）CR2例（12．5％）NCR5例（31．3％）PR6例（37．5％）MR1例（6．2％）。总有效率87．5％,主要缓解率81．3％。最常见的不良反应为胃肠道症状、血小板减少、疲乏,经对症治疗后均缓解;硼替佐米联合化疗是治疗复发难治性多发性骨髓瘤的一种新的安全有效的治疗手段。     

多发性骨髓瘤11例临床分析

多发性骨髓瘤是浆细胞恶性瘤中最多见者，作者报告了我科诊治的１１例ＭＭ患者，男女性别无明显差异，发病年龄４９－６７岁，平均年龄５６．１岁，ＭＭ临床表现多样化，给诊断带来一定的困难。本组１１例首次就诊确诊者３例，仅占２７５误诊８例，占７３％，误诊时间最长为３年。本组５例患者接受化疗，２例无效；１例进步，缓解２例。     

应用醋酸纤维薄膜电泳发现二例多发性骨髓瘤

应用醋酸纤维薄膜为载体做血清蛋白电泳时,出现M—蛋白带的图谱,近来国内曾有报道。我们化验室在以前也曾发现过M—蛋白血症,今年九月又连续发现二例。当时临床无明显多发性骨髓瘤的症状,因而误诊为肝肾综合症和髋关节炎。其中一例门诊化验肝功能发现锌浊度明显增高(40单位),     

老年多发性骨髓瘤的特殊临床表现

多发性骨髓瘤（MM）多发生在中、老年患者。临床表现多以骨痛、肾脏损害及贫血为主,但亦可复杂多样,容易漏误诊。现将我院收治7例老年多发性骨髓瘤患者的特殊临床表现作一简述,以求教于同业。1 临床表现1.1以神经系统为主要表现。MM引起神经系统损害约占40%—60%,其发生机理为：骨髓瘤细胞直接浸润,肿瘤压迫及骨质破坏;贫血、出血;M蛋白所致高粘滞综合征以及泻粉样变性;断发性感染;化疗及化疗的副作用。以上因素可致周围神经病变、截瘫、颅神经损害、脑内损害等常被误诊为“神经系统疾病”,或因截瘫及椎体破坏而误诊为“脊柱结…     

CpG岛甲基化检测方法

目的：建立CpG岛甲基化测定方法,方法：收集20例急性粒细胞性白血病（AML）,18例多发性骨髓瘤（MM）,14例骨髓异常增生综合征（MDS）,15例慢性粒细胞性白血病（CML）及20 例正常对照组的外周血,分离单个核细胞,提取DNA,应用CpG岛思虑在化特异的方法（MSP－PCR）,测定P15和P16基因甲基化情况,结果：P15和P16基因甲基化在各种白血病的表率率分别为AML 80％和70％,MM72．2％和66．7％,MDS 57．1％和50％,CML0％,结论：P15及P16基因甲基化在AML,MM及MDS中有较高表达,而在CML中不表达。     

多发性骨髓瘤与骨转移瘤的X线及CT鉴别诊断

目的：为了提高对多发性骨髓瘤（ＭＭ）和骨转移瘤的影像学（Ｘ线,ＧＴ）的鉴别诊断水平,方法：收集经骨髓涂片或局部病灶活检病理证实的ＭＭ４４例。经手术、病理证实原发肿瘤并骨重破坏者７１例;骨破坏灶穿刺病理为骨转移瘤５例。将上述两组病例的Ｘ线及ＣＴ表现进行回顾性分析对比。结果：颅骨病变发生率ＭＭＯ ８５％,骨转移瘤为２１．４３％,两者比较Ｐ〈０．００５;下颌骨破坏ＭＭＯ ５０％,骨转移瘤为７．１４％,两     

胸部骨骼多发性骨髓瘤和骨转移瘤的X线及CT鉴别

目的 :探讨多发性骨髓瘤 (MM)与骨转移瘤 (BM)胸部骨骼受侵的X线及CT所见的不同。方法 :搜集经骨髓涂片或活检 ,病理确诊MM 36例 ,另搜集手术病理确诊为原发恶性肿瘤并骨受侵 6 7例和骨破坏病理活检为转移瘤但未找到原发灶的 3例。对两组病例胸部X线及CT影像进行分析比较。结果 :锁骨、肩胛骨、胸骨和肱骨上段受侵发生率二者差异有显著性 ,而肋骨则无显著性 ,但破坏呈膨胀型或圆、类圆型时 ,二者发生率差异有显著性 ;并发软组织肿块之发生率二者差异无显著性 ,但CT上二者各有不同特征。锁骨及肩胛骨受侵 ,呈圆、类圆型破坏发生率二者差异有高度显著性。BM胸片上可有原发及继发肺癌 ,纵隔、肺门淋巴结转移征象 ,而MM则极为少见。结论 :根据胸部各骨受侵部位、破坏类型、软组织肿块CT表现 ,有无原发、继发肺癌征象 ,在胸片上是有可能鉴别MM与BM的     

骨髓涂片检测急性淋巴细胞白血病微小残留病的意义

为了建立一种简便、快速的微小残留病的检测方法,采用聚合酶链反应技术,选择３年内的急性淋巴细胞白血病骨髓涂片标本,进行免疫球蛋白 Ｉｇ Ｈ 和 Ｔ 细胞受体ｒ 链基因重排的检测．其结果１８ 例初诊病例的骨髓涂片标本中, Ｉｇ Ｈ 阳性率７２ ．２ ％ ,与初诊骨髓液标本的 Ｉｇ Ｈ 阳性率７３ ．７ ％ 对比基本一致［１］ ．说明骨髓涂片能进行微小残留病的检测,这对于临床考察急性淋巴细胞白血病的缓解和预测其早期复发均具有一定的临床意义     

IgE myeloma with elevated level of serum CA125

Objective: To explore clinical and laboratory features and significance of detecting serum carbohydrate antigen 125 (CA125) in immunoglobulin E (IgE) multiple myeloma. Methods: We reported the clinical findings of a male patient with IgE myeloma and elevated level of serum CA125 and reviewed the literature. Results: Laboratory tests of this patient on admission showed extremely high serum IgE and CA125, a bone marrow aspirate revealed abnormal plasma cells (38.4% of nucleated cells: 16.4% mature and 22% atypical), and in bone marrow biopsy, immunoperoxidase staining showed positive cytoplasmic staining for IgE and κ light chain within the vast majority of plasma cells. Computed tomography (CT) bone scans indicated wedge shape change and compressive fracture of thoracic vertebrae, and emission computed tomography (ECT) discovered multiple punctiform aggregation of radiation in both cervical ribs and spine. The serum IgE and CA125 gradually decreased to normal limits after eight cycles of chemotherapy. This patient is alive well with an 18-month complete remission. Conclusion: We reported the first case of IgE myeloma with elevated level of serum CA125. To further evaluate clinical characteristics and significance of CA125 in IgE myeloma, more cases are needed.     

Accumulation of a heat shock-like protein during differentiation of human erythroid cell line K562

The human erythroid cell line K562 provides a model system for studying erythroid differentiation and eukaryotic gene regulation. These cells express glycophorin A, spectrin and i antigen. They accumulate embryonic and fetal haemoglobins on induction of erythroid differentiation with haemin, sodium butyrate or hydroxyurea. In the present study, the protein composition of K562 cells during haemin-mediated induction of erythroid maturation was analysed by two-dimensional gel electrophoresis. Under conditions in which haemin did not effect cell viability and proliferation, a protein of approximately 70,000 molecular weight (MW) accumulated in the differentiated K562 cells. The accumulation appears to be due to an increase in the rate of RNA synthesis for this protein. The protein is related in sequence to a 70,000-MW heat shock protein. An antigenically related protein was also demonstrated in human bone marrow and accumulates at particular stages of human erythroid maturation.     

Diversity of immunoglobulin expression in leukaemic cells resembling B-lymphocyte precursors

Approximately 20% of patients with acute lymphocytic leukaemia (ALL) have leukaemic blasts with features of pre-B cells which are the recently characterized precursors of B lymphocytes in normal development (for a review, see ref. 2). Pre-B cells isolated from normal bone marrow or fetal liver, and malignant cells from patients with pre-B cell leukaemia, are rapidly dividing lymphoid cells that contain cytoplasmic immunoglobulin mu heavy chains, but have no detectable surface immunoglobulin. The resemblance of immunoglobulin-containing ALL cells to normal precursors of B lymphocytes and their availability in relatively pure preparations allowed us to explore them as models of early stages in the differentiation of the B-lymphocyte line. We report here observations on the occurrence of intermediate pre-B/B-cell phenotypes, immunoglobulin isotype switching and the asynchrony of immunoglobulin heavy and light chain expression in 30 cases of ALL and 3 cases of chronic myelogenous leukaemia in lymphoblastic crisis (CML-BC).     

间歇式短距离运动训练对贫血患者重组促红细胞生成素的影响

研究间歇式短距离训练对贫血患者重组促红细胞生成素的影响,为了便于分析,选用50只患有贫血症的Wister雄性大白鼠作为研究对象,随机将其划分成对照组和间歇式短距离运动训练组,间歇式短距离运动训练组进行相应训练,对照组在实验期间不进行任何训练,饲养环境和间歇式短距离运动训练组相同。和对照组相比,间歇式短距离运动训练组运动2~3周的体重明显更低,差异具有显著性(P0.05);间歇式短距离运动训练组在实验4~7周时的体重低于对照组,差异具有非常显著性(P0.01)。当实验时间为1周时,对照组和间歇式短距离运动训练组大鼠血清EPO浓度、骨髓细胞EPO mRNA表达和蛋白表达无显著性差异(P0.05);当实验时间为2~7周时,间歇式短距离运动训练组大鼠血清EPO浓度明显高于对照组,差异具有显著性意义(P0.05),间歇式短距离运动训练组大鼠骨髓细胞EPO mRNA表达和蛋白表达明显高于对照组,差异具有非常显著性意义(P0.01)。训练1周后,间歇式短距离运动训练组大鼠骨髓细胞中有少量表达EPO细胞,训练2~3周后,训练组大鼠骨髓细胞中的表达EPO细胞有所增加,随着训练时间的逐渐增加,大鼠骨髓细胞中表达的EPO细胞越来越多,对照组大鼠在训练结束后骨髓细胞中仍有较少的表达EPO细胞。间歇式短距离运动训练有助于贫血患者促红细胞生成素的重组。     

Continued RAG expression in late stages of B cell development and no apparent re-induction after immunization.

Models of B-cell development in the immune system suggest that only those immature B cells in the bone marrow that undergo receptor editing express V(D)J-recombination-activating genes (RAGs). Here we investigate the regulation of RAG expression in transgenic mice carrying a bacterial artificial chromosome that encodes a green fluorescent protein reporter instead of RAG2. We find that the reporter is expressed in all immature B cells in the bone marrow and spleen. Endogenous RAG messenger RNA is expressed in immature B cells in bone marrow and spleen and decreases by two orders of magnitude as they acquire higher levels of surface immunoglobulin M (IgM). Once RAG expression is stopped it is not re-induced during immune responses. Our findings may help to reconcile a series of apparently contradictory observations, and suggest a new model for the mechanisms that regulate allelic exclusion, receptor editing and tolerance.     

DDR相关蛋白缺陷引起的原发性免疫缺陷表型研究进展

在细胞内可变区基因(多样化基因)连接区基因片段重组(variable(diversity)joining recombination,V(D)J)与免疫球蛋白的类别转换重组(class switch recombination,CSR)过程中会产生程序性DNA双链断裂(DNA double strand break,DSB).当检测到DSB发生时DNA损伤反应(DNA damage response,DDR)被启动.DDR缺陷的病人具有原发性免疫缺陷表型(primary immunodeficiency,PID).总结了V(D)J重组与CSR产生DDR的分子机制,综述了V(D)J重组与CSR过程中DDR相关蛋白缺陷引起的原发性免疫缺陷表型.