多发性骨髓瘤的基本知识
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">多发性骨髓瘤<span style="color: black;">亦</span><span style="color: black;">叫作</span>为浆细胞骨髓瘤,是浆细胞<span style="color: black;">出现</span>恶变,<span style="color: black;">海量</span>单克隆的恶性浆细胞增生<span style="color: black;">导致</span>。肿瘤多侵犯骨质和骨髓,产生溶骨性病变。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、病因:尚不<span style="color: black;">知道</span>,可能与遗传、电离辐射、炎症及慢性抗原刺激等<span style="color: black;">相关</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.症状与体征</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(1)<span style="color: black;">没</span>症状:<span style="color: black;">起始</span>可<span style="color: black;">没</span>症状达数年,<span style="color: black;">乃至</span>10余年。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(2)骨痛:骨痛是最<span style="color: black;">重点</span>的症状,多为首发症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(3)贫血、<span style="color: black;">流血</span>、感染<span style="color: black;">导致</span>的表现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(4)骨压痛:病情<span style="color: black;">显著</span>时可有病变处的骨压痛。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.辅助<span style="color: black;">检测</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(1)外周血涂片:可见到幼红、幼粒及少量浆细胞。浆细胞的数量大于20%或绝对计数大于2.0×10工就<span style="color: black;">叫作</span>为浆细胞白血病。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(2)骨髓象:浆细胞<span style="color: black;">通常</span>大于10%,达15%才达国内诊断标准。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(3)M蛋白( monoclonal protein)峰:<span style="color: black;">按照</span>所分泌免疫球蛋白的种类,将多发性骨髓瘤分为8类:1gG型占60%;IgA型占20%;lgM型、1D型、lgE型少见;轻链型20%;非分泌型占2%;双克隆<span style="color: black;">反常</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">型占2%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(4)尿本周蛋白:阳性占40%-70%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(5)血钙<span style="color: black;">升高</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(6)肾功能损害。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(7)骨X线片见溶骨性病变,最多见于颅骨、肋骨及脊椎。骨质硬化仅占1%<span style="color: black;">上下</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5.组织学分型</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(1)间质性:有少量散在的癌细胞在骨髓间质中分布。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(2)小片性:骨髓内瘤细胞<span style="color: black;">重点</span>呈小片状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(3)结节性:骨髓内瘤细胞分布呈结节性。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(4)弥散性:骨髓内<span style="color: black;">海量</span>瘤细胞充满髓腔。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗原则:化疗是本病的<span style="color: black;">重点</span>疗法,对骨破坏所<span style="color: black;">导致</span>的<span style="color: black;">病痛</span>可用放射治疗。</p>
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