C H U Y S N Bi: Hpi NGH| KHOA HQC HUVe'T HQC • TRUYJN M A U T O A N Q U 6 C 2012
NGHIEN CUU DAC D I ^ M O I E N DI PROTEIN HUY£^T THANH VA D I E N Dl Ctf DjNH M | £ N DICH GAP il 142 B | N H N H A N DA U TUY XUDNG D I ^ U TR!
TAI VliN HUY£T HQC - TRUYiN M A U TRUNG UDNG Ttif 2010-2012
U XuAn HAi', Khong T h j D i $ p " , U VAn OSn;'
T6M TAT
Uln d8u WSn t^l Vl^n Huyft hpc - TruySn mAu Tmng uUng trien khai ky thu$t dien dl mao quAn protein kft hpp vdt dl|n cd d|nh miln djch mao quAn. Nghien ciiu nAy khAo sAt huySt thanh ciia 142 b$nh nhAn da u hJy xuOng dISu trj t^il Vl^n bong thdi gian tir 2010-2012 cho thSy: TSt cA cAc b^nh nhAn dSu xuSt hl^n dinh ddn ddng, trong dd chii y€u IA ki^u hlnh mdt dinh ddn ddng, d vj M y-globulln. Ty 1$ bSt gAp cAc kiKu hinh mien dfch glAm dAn t i i IgG, IgA, chuil nhp va IgM. Vdi cac kleu hinh IgA vA IgG, t)i Ip gAp chuoi kappa nhieu hon so vdi lamba. Vdi kleu hinh chuol nhe ddn thuan, ty 1^ gAp chuol nhe lambda chiem uU the. Nghien ciiu cung bAt gAp mpt sp kieu hinh mien djch it gAp, cd 2 dinh ddn ddng nhu tc hpp IgA-IgA, IgG-IgG va IgA-IgG.
Kleu hinh chuol nhp chi gAp d glal doan 2 vA 3 ma khong gAp d glal doan 1 ciia b^nh, ty le kleu hinh IgA d glal doan 3 thSp hdn so vdi d glal doan 1 va glal doan 2 .Ty 1^ cAc kleu hinh mien dich tuOng duVng nhau glQ:a nhdm bpnh nhAn cd thieu mau vA khdng thieu mAu, giiia 2 nhdm benh nhan cd dau xupng vA khdng dau xuUng
Ky thuat cho ket quA nhanh vdi dp nhay cao, cho phep phAt hien ca cAc triidng hpp cd dinh prcteln ddn ddng ma khdng cd ty 1^ A/G dao ngupc trong cAc trudng hpp benh nhAn den sdm hoAc da qua dieu trj.
Tu' khoi: Ba u tiiy xUBng, dien dl map quan protein, cddinh mien dich.
1) Khoa Mien dich - Dl truyen & Sinh hgc phan tti', vien Huyet hgc-Truyen mau Trung uang 2) Bd_ mon Sinh ly benh- Mien dich. Bar hpc Y Thai t 3) Bo mon Mien dich, Hgc vien Quan y
Phan bien khoa hpc: GS.TSKH. Bd Trung PhAn
SUMMARY
CHANGES I N SERUM PROTEIN CAPILLARY ELECTROPHORESIS AND IMMUNOFIXATION PATTERNS OF 142 PATIENTS WITH MULTIPLE MYELOMA ADMINISTERED TO THE NATIONAL INSTITUTE OF HAEMATOLOGY AND BLOOD
TRANSFUSION
This Is, for the first time, the combined Immoflxatlon and protein capillary electrtiphoresis being implemented at the National Institute of Haematokigy and Blood Transfuston. Tills research examined serum samples of 142 multiple myekxna patients administered to die institute between 2010 and 2012. All patients had monoclonal pk:k(s) on caplllaiy electrophoresis spectra, among that most of cases were single protein at the ygloliu""
position. The frequencies of Immonotypes were IgG, IgA, light chain and IgM In the decrement orders. Among the IgG and IgA Immunotypes, kappa chain was seen more often than lambda one. In the cases of light chain alone, the lamtxfa chain was dominant. Some rare Immunotypes with two monoclonal peaks were also seen sudi as IgA-IgA, IgG-IgG and IgA-IgG combinations.
Keywords: f4ultiple myeloma, protein , capillary electrophoresis, Immunoflxatlon. |
Y HQC VlgT NAM T H A N G 8 - s 6 D A C B I 6 T / 2 0 1 2
I. OAT VAN OE
ba u tiiy xucmg (DUTX) \k b?nh ung thu tucmg bao, thupc tuy xuong v6i sy c6 m^t cua ton thuorng xuofng, tang tucmg bdo non, xudt hi^n protein don d6ng trong huy^t thanh v£l nude tieu, dau xuong, tfing can-xi m6u vd thi^u mau. So lu<7ng tuong bdo tdng qud miic va cdc Ig duQfc tiet ra b^t thu6ng gdy ra nhihig bieu hi$n b^nh I^ trSn ldm sdng ci^a da u tu;? xuong [8]. Su tdng sinh dc tfnh ciia cdc tuong bdo s€ Idm tdng sdn xu^t vd ch^ ti^t cac globulin mi€n djch (Ig) c6 tfnh don ddng (monoclonal immunoglobulin) c6n du<;rc gpi Id protein M. Trong hau het cdc tru^g hpp, cdc tuong bao c6 the sdn xuAt cdc chuoi n$ng, do do cdc Ig dugrc t6ng hgp todn v?n gom cd chuoi ndng vd chuoi nh^ (DUTX
^chuSi n$ng). Trong mpt so tru6ng hgp khdc,
|cdc tl bdo u tuy xuong chi sdn xuat chuoi nh?
cua Ig (chuoi lambda hodc chuoi kappa). Cdc protein nay dupe gpi la para-protein hay protein Bence Jones va dang b?nh nay dyoc gpiila DUTX chudi nhe (lambda hay kappa),
^ i so lupng cac Ig thay doi se lam cho ddc di&n Sndi protein huyit thanh thay d6i [ 1 ], [8].
Difn di protein de xac djnh su co m$t cua protein M trong mau va trong nuoc tilu
<^ dupe dung nhu mpt xet nghifm thuong qui dl chan doan DUTX. Tuy nhien, phuong phap ndy con mgt so han che la dp nhay thap vd chua chi ra dupe lop va chuSi Ig gi co lien quan d6n benh. Ky thuat dien di mao qudn phoi hpp dien di protein voi dipn di c6 djnh mien djch mao quan co nhi6u uu diim, khdc phyc dupe cac han chi cua dipn di protein thong thucmg. Ky thuat nay khong nhOng chi ra dupe I6p va chuoi Ig gi eo lien quan din b§nh ma eon co dp nhay cao, co kha ndng phdt hifn som su xudt hien cua protein M khi chua CO su thay dfii vl lupng globulin, ddc biet la voi cac benh nhan con 6 giai doan
sdm ciia bfnh hay dd qua dieu trj [7]. Lan dau ti6n ky thudt ndy dugc triln khai t^i Vifn Huyit hpc • Truyin mdu Trung uong (Vifn HH-TMTW), tir d6 nghiSn cihi ndy dugc tiln hdnh nhdm khdo sdt cdc d^ng biin d6i hinh dnh difn di protein vd kilu hinh miln djch trSn difn di mien djch mao qudn huyit thanh ciia cdc bfnh nhfin DUTX dupe diiu trj t^ Vifn.
II. 0 6 l TOClNG VA PHUONG P H A P N G H I I N C O U
2.1. B&i tvpmg
142 bfnh nhan duprc chin dodn xdc djnh Id DUTX theo tiSu chu4n cua h^i DUTX qu6c te dua ra ndm 2003 [7] du^rc diiu trj t^i Vifn HH-TMTW tir thdng 12/2010 din thdng 3/2012. Trong d6 co 75 ntt (52,8%) vd 67 nam (47,2%). Tuoi mdc bfnh trung binh cua cd 2 gidi Id 61 (cao nhdt la 86, thdp nhAt Id 26).
2.2. Phirong phap
2.2.1. Di^n di mao qudn protein huyet thanh:
Difn di mao quan protein huyit thanh thuc hifn tren he thdng CAPILLARYS 2 (Sebia, Phdp) vdi phdn mim phdn tich Capillarys 2 Version 5.07 theo phuong phdp dugc Gay-Bellile mo td ndm 2003 [5].
Nguyen ly ky thuiit cd the tdm tdt nhu sau:
Trong mdi trudng pH kiem, cdc phan tii protein tich difn am se di chuyen ve c\rc duong dudi tdc dung cua dong difn 1 chieu.
Qud trinh dien di se lam phan tdch protein huyit thanh thanh 6 thdnh phan: albumin, al- globulin, a2-globulin, pi-globulin, P2- globulin va y-globulin dua vao difn tich cua chung. Kit qud difn di protein cho biet: Ty If
% tCmg lo^i protein; Ty If A/G = albumin/(al + a2 + P + 7) globulin; Cd hinh dnh dinh don ddng hay khong; Hinh dnh protein don ddng 1 dinh hay 2 dinh va thupc phan nao cua globulin huyet thanh.
C H U Y S N Bi: H Q I N G H | KHOA HQC HUYgT HpC • TRUvgW M A U T O A N Q U 6 C 2012
212. Difn dl ci dfnh mlin djch mao quin:
Difn di mao quin protein huy^t thanh th\tc hifn trSn hf thing CAPILLARYS 2 (Sebia, Phip) vdi ph^n mim phin tich Capillarys 2 Version S.07 theo phuong phip duoc Oay-Bellilc md ti nim 2003 [3], Nguyfn if k$> thuft cA thi tAm tit nhu sau:
Tni6c khi dirprc difn di, miu huyft thanh dufic chia lim S phihi cho ch^y qua eft sic ky miln dich chura cic khing thf dfc hifu khing chuSi nfng gamma (y), alpha (a), muy (|i), chuSi nhf kappa (K), lambda (\) df lo^i bd chpn Ipc IgG, IgA, IgM, chuSi nhp kappa
III. K ^ QUA VA BAN LU$N:
3.1. D$c diim difn di protein
hofc chuSi nhp lambda. Sau khi difn di HIM phuong phip difn di protein nhu tren, tg sinh hinh inh difn di cCia cic mau huy^
thanh chfiy qua c$t sic kf mien djch v6i miu huy^t thanh kh6ng ch^y qua cpt sic ky miln dich, dinh don d6ng mit di 6 ph6 sic ky sau khi ch^y qua cOt sic k^ chijta khing thf nio thi kit qui protein dem ddng tuong irng vii khing thi dfc hifu A cdt dd.
Xft nghifm difn di protein vi difn i^
miln dich mao quin trfn miy S E ^ ^ CAPILLARY 2 t^i Khoa Miln djch - B truyin & Sinh hpc phin tur, Vifn HH- TMTW.
. 1 <fi pi p V
a) Binh thudng (khdng cd dinh don ddng) globulin)
ll
b) 1 dinh don ddng (t?i vi tri y-
c) 1 dinh don dong (t?i vj tri P-globulin) d) 2 dinh dom dong (t^ii vi tri y- globul Hlnh 1: Mpt sd djmg dinh don ddng gfp trong nghiSn cihi niy
•?.a,.',
K g g /
W "*
f n
:'T> If %
Y HOC VI$T NAM THANG 8 • S6 SAC Bif T/2012 Dfc diem d i f n di protein
SS dinh ddn ddng Idlnh
129 90,8
2 dinh 13 9,2
V| tri dinh dtfn ding y- Globulin
131 92,3
%- Globulin 11 7,7
Tl^lf A/G A/G<1
120 84,5
A/G 2 1 22 15,5 Nhin xet: • Dinh don ddng xuit hifn d
100% bfnh nhan. Trong dd kilu hinh 1 dinh don ddng chiim chCi yiu (90,8%), kieu hinh miln dich 2 dinh dtm ddng chiim t^r If It (9,2%). Kit qui niy cflng phd hpp vdi nghifn cihi cia Nadeem A Ansari [4],, ty If xuat hifn kilu hinh nhiiu hem 1 dinh don ddng bong nghifn ciiu cua chung tdi cao hem so vdi nghien ciiu ciia Robert A Kyle t^ My (2 dinh don ddng chiem 2%)[6),
- Vi tri xuat hifn dinh don ddng: Dinh don ddng chii yeu xuat hifn d vj tri y- Globulin (92,3%), it gfp d vi tri P- Globulin, khong gfp dinh don ddng nio xuat hifn d V) tri a- Globulin. Kit qui nghifn ciiu ciia ching tdi khic so vdi kit qui nghifn cihi cia
^ 3J. Bjc diem difn di mien djch
Robert A Kyle t^ii My (52 % d vi fri y- Globulin , 13 % d vi tri P- Globulin, 12%
giiia y- Globulin vi P- Globulin, I % d vi tti a- Globulin)[6] . Sir khic bift niy c6 thi li do dii tirpmg nghiin cihi li nhfhig bfnh nhin d nhflng vflng dia ly khic nhau, cd nhiing dfc diim khic nhau.
- Ty If A/G : Ty if A/G dio ngupc (A/Q
<1) trong da so cic ttudng hpp (84,5%). Ty if A/G binh thudng (A/G>1) chiim mpt ty If nhd (15,5%). Ket qui nay cung phu hpp vdi dfc diem thay ddi protein trong da u tuy xuong nhu md ti ttong y vin: Ting gama globulin, giim Ig binh thudng, giim Albumin, ty If A/G dio nguoc.
Hinh 2: Hinh inh difn di mao quin protein huyet thanh (a), va ket hprp dien di mao quin
»oi c6 dinh mien dich (b-f). Kit qui difn di mien dich mao quin cua bfnh nhan DUTX cd (tinh don ddng Ii IgG chuoi lambda, do dinh don ddng mit di d cac phd dien di sau khi cd linh vdi khing thi khing IgG (b) vi khing chuoi lambda (f).
CHUYBN BJ: HQI NGHI KHOA HpC HUYgT H<?C • TRUYJN MAU TOAN QUfic 2012 3.3.Cic kiiu hlnh mlin djch cia dlnh dan idng
Bing 2: Cic kilu hlnh miln djch ciia dlnh don ddng Kiiu hlnh mlimlleh
ChuSi nhe IgA IgG IqM 2 dlnh T«na
TSng (n)
8 20 99 2 13 142
(%)
5,6%
14,1%
69,7%
1,4%
9,2%
100% 1 aoo«
90K 80K 70K 60W SOK 4 0 « 30K 20K lOK 0 %
r"
1' -
\-
- •\
4^
1
n
ChuAi nhe
y 7
a Lambda
• Kappa
Bliu do 1: Cic kilu hinh mien dich cua I dinh don ddng Nhdn xet: Kilu hinh mien dich hay gfp
nhit li IgG (99/142= 69,7 %), tiip den li IgA (20/142=14,1%), 2 dinh don ddng (13/142=9,2%), chuoi nhp don thuin (8/142=5,6%), vi chi gfp 2 trudng hpp IgM (1,4%). Ket qui nghien ciiu cho thay ty If IgG cao hon, ty If IgA thip hon so vdi kit qui cua Vd Th] Thanh True (lgG=63,5%, IgA= 33,5%)[2], Robert A Kyle (IgG= 52%, IgA 2I%)[6], Edgardo J.C. Angtuaco (lgG=60%, IgA = 25%)[3]. Kilu hinh chuoi
nhp dom ddc chiem ty If thap hon so vdi kel qui nghifn ciiu cCia Robert A Kyle[6]. Vdi cic kieu hinh IgA va IgG, ty If gfp chuSi Kappa nhiiu hon so vdi Lamba, kit qui osy phil hpp vdi nghifn ciiu ciia Vd Thi Thanii Tnic [2] , Robert A Kyle [6], cdn vdi Idju hinh chuoi nhp don thuin thi ty If gfp chuS nhp Lambda chiem im thi. Cd su khac bi?t vl ty If cac kieu hinh mien dich nay c6 le li do cic nghien ciiu duoc thuc hien d cac viing dia ly khic nhau.
Y HQC Vlf T NAM THANG 8 • s6 CAC BI6T;201 2
3.4. Ty If xuil hlfn cic kiiu hinh mlin djch cia 1 dlnh dem ddng theo gldl Bing 3: Ty If xuit hifn cic kilu hinh miln djch cfla 1 dinh dom ddng theo gidi
KlSu hinh miln d|ch IgA IgG IgM Chuol nhp
Tfing
Nam n 15 43 1 3 67
<M>
22,4 71,6 1,5 4,5 100
Nir n 5 56
1 3 75
%
6,7 82 1,3 4 100
P p<0,05 p>0,05 p>0,05 p>0,05
Ty If xuit hifn cia kilu hinh miln dich IgA d nam cao hom d ntt (p<0,05). Cic kilu hinh liin dich IgG, IgM vi chuSi nhp 6 ci 2 gidi li nhu nhau.
3.S.Tylfxuit hifn kiju hlnh mlin djch cualMidmdbnxtheodltuil.
aiBtwi
• ChuAi nh«
Bliu db 2: Ty If xuit hifn kilu hinh miln dich cCia I dinh dom ddng theo dp tuii d tit ci cic nhdm tudi df u thiy hay gfp nhit la IgG, tiip din la IgA. IgM chi gfp d nhdm tudi tit 70 trd len, chuoi nhe don thuin khdng gfp d nhdm tudi tir 70 ttd Ifn.
3.6. Cic kiiu hlnh mlin djch cua 2 Oinh dm ddng
0 IgA-lgA D IgA-IgG
• IgG-IgG
6 1 %
Bliu dd 3: Cac kilu hinh mien dich cua 2 dinh don ddng
Trong nghien ciru cung bit gap mdt so kilu hinh mien dich it gfp, cd 2 dinh dom ddng
CHUYEN Bi: Hpi NGHI KHOA HQC HUY£T HQC • TRUYJN MAU TOAN QU6C 2012 nhu tl hpp IgA-IgA, IgO-IgG vi IgA-IgG, trong dd tl hop lgA-IgA(8/l3= 61,5%), IgG- IgG(4/l 3= 30,8 %), chi bit gfp 1 trudng hprp IgA-IgG (7,7%). Khdng bit gfp trudng hpp nio cd tl hop dinh don ddng IgM-IgM hofc IgM vdi IgA hay IgG. Kit qui nghifn cliu cua chiing tdi cd su khic bift so vdi nghifn curu cOa Ansari: IgA-IgG (33%), IgM-IgG (24%), IgG-IgG (17%), IgM- IgA(8,5%), IgM-IgM(8%)[4]. Tuy nhifn trong nghifn ciru ciia chiing tfi, ^ lupng bfnh nhin cd cic kilu hinh tl hop 2 dinh don ddng cdn it, ndn sy so sinh kit quidna chinh xic, cin phii nghifn ciru vdi sl luong bfnh nhin nhiiu hom.
4. Mil lifn quan gin's kilu hlnh miln djch vdi cic trifu chihig lim sing vi cfn lan sing khic.
4.1 Mil liin quan gilta kiiu hlnh mlin djch vi Ihliu miu.
Bang 4. Lien quan gitta kilu hi Klfu hlnh
miln djch Chuoi nhe
IQA IqG IqM 2 dinh Tonq
nh mien dich v Thif u miu (Hb<100g/l) n 4 14 64 2 10 94
%
4,3 14,9 68,1 2,1 10,6 100
i thiiu miu Khdng thISu miu
(Hb>lCOq/l) n 4 6 35
0 3 48
%
8,3 12,5 72,9 0 6,3 IOC
P p>0,05 I)>0,05 i p>0,05 p>0,05 D>0,05 Ty if xuit cic kilu hinh miln dich d ci 2 nhdm thiiu miu va khdng thieu miu tuong duong nhau
4.2. Mil liin quan gitta kiiu hlnh mlin djch vi dau xuomg Bing 5. Lien quan giaa kilu Mnh miln djch vi dau xuong
Kieu hinh mien dich Chuoi nhe
IqA IqG IqM 2 dinh
Tonq
Cddauxutfng n
6 11 59 0 6 82
%
7,3 13,4 72,0 0 7,3 100
Khdnq dau xUdnq n
2 9 40 2 7 60
%
3,3 15,0 66,7 3,3 11,7 100
P D>0,05 D>0,05 D>0,05 D>0,05 i D>0,05 1 Ty If cic kieu hinh miln dich gitta 2 nhdm dau xuomg vi khdng dau xuong li nhu ti 4.3. Moi lien quan gilta kiiu hlnh mlin djch vi glal dopn bfnh
Bing 6. Lien quan gitta kieu hinh mien dich vi giai doan benh Kleu hinh
mien dich Chuoi nhe
IqA
Giai do^n I (1) n 0 8
%
0 20,0
Glal doan I I (2) n
3 10
°/o 5,4 17,9
Giai doan I I I (3) n
5 2
»/o 10,9 4,3
P J
Pu>0,05l D,-,<0,05j
yrtftwit jfetG » • S6 OAC Bif T/2012
75.0\ .,: ^B 67,8 P"<°-°5
Pi"i>0-05
. i l l . 2.2 Pi-'»>0.°5
2 dlnh .JJL. 8,9 P<'^>°.05
» TSng 40 100 56 100 46
Glal dopn 1:02 microglobulin < 3,5 mg/1 vi Albumin i 35 Glal dopn 11: B2 microgkibulln < 3,5 mg/1 vi Albumin < 35g/1
ho^ 3,5< p2 microglobulin < 5,5 mg/1 Glal doan m: 02 microglobulin >S,Sma/l
Nhfn xil: Ty If xuit hifn cic kilu hinh miln dich IgO, IgM, 2 dinh dom ddng d cic giai doan bfnh li nhu nhau, kilu hinh chuli nhp chi gfp d giai d o ^ 2 vi 3 mi khdng gfp d giai dojn I cua bfnh, ty If chuli nhp d giai d o ^ 3 cao hon so vdi giai d o ^ I vdi p<0,05, cd 16 do dfc diim cfla chuSi nhp dl ling dpng d thfn giy ndn ton thuong thfn ndn bfnh dl tiln ttiln nhanh sang giai d o ^ 2, 3, thdi gian d giai d o ^ I ngin ndn khd bit gfp kilu hinh niy d giai do^-1. Tuy nhidn s6 lupmg bfnh nhin cd kilu hinh chuoi nhp ttong nghidn ciiu niy cdn it nfn cin cd nghifn ctiru vdi sl lirpmg bpnh nhin Idn htm. Ty If kilu hinh IgA d giai d o ^ 3 thip hon so vdi d giai doan I vi giai do?n 2 vdi p <0,05.
4.4. Mil liin quan gilta kiiu hinh mlin djch vi Ion Ihirttng than Bang 7. Lien quan gitta kilu hinh miln dich vi ton thuong thin
Kleu hlnh miSn djch Chuoi nhe Chuoi nanq
Idinh 2 dinh
Khdng t£n thu'dng thfn (Creatinin £ 173 mmol/1)
n 5 120 113 12
»/o 4,0 96,0 90,4 9,6
Cd ton thu'dng thfn (Creatinin > 173mmoI/l)
n 3 14 16 1
%
17,6 82,4 94,1 5,9
P p<0,05 p<0,05 p>0,05 p>0,05 Nhfn xit: (i nhdm cd tin thuomg thfn, kilu hinh mien dich chuoi nhe chiim ty If cao hon, kilu hinh chuoi nfng chiim ty If thip hon so vdi d nhdm khdng tin thuang thin (p<0,05). Kit qui niy li do cic chuoi nh? cd ttong luong phan tu thip nen xuyen qua mang Ipc cau thfn mpt cich dl ding, su thay ddi dfc tinh ly hoi cua nude tilu d cic dng than cd thi lam cho cac ptotein chuoi nhp tita l^i dudi d ^ g cic tru acid cd ciu tnic li mdng. Khi tiep xue vdi cic tru niy, biiu md dng thfn bi teo vi thoii hoi tdn thuong thfn va hfu qui thudng gfp li suy thfn. Ty if kilu hinh I dinh vi 2 dinh don ddng d 2 nhdm Ii nhu nhau.
V. KET LUAN
Q\3a nghien ciiu hlnh inh difn di protein va difn di cd dinh miln dich huyit thanh d 142 bfnh nhan da u tuy xuomg chiing tdi thiy motj^ dfc diim sau:
i . Chfl yiu gip kilu hmh I dinh don ddng
(90,8%), ttong dd 92,3% gfp dtoh don ddng y- globulin, 7,7% gap dinh don ddng p-globulm.
2. Kilu hinh 2 dinh don ddng chi gfp 9,2%, chu yiu gip kilu phdi hop dmh IgA-IgA
3. 84,5%i benh nhan da u tuy xuong cd ty If A/G dao nguoc.
4. Hay gap nhat da u tuy xuomg chudi
C H U Y S N pg: HQI N G H | KHOA HQC HUYgT HQC • TRUYJN M A U T O A N Q U 6 C 2012 nfng IgO (69,7 % ) , tiip din l i da u tfly
xuong chuii nfng IgA (14,1%). Da u tiiy xuong chuli nfng IgM chi gfp 1,4%. Trong da u tiy xuomg chuli nfng, ty If gfp thi phii hprp chuli nhp kappa cao hon thi phii hprp chuli nhp lambda.
5. Da u tfly xuomg chuli nhp chiim 5,6%, trong dd ty If da u tfly xuomg chuoi nhp lambda hay gfp hon.
TAI l l f u THAIM K H A O
1. D l Trung Phin (2003). Da u tuy xuong.
Bfnh ly tl bio nguin tao miu: Chin doin- Phin loai vi Dieu trj. NXB Y hpc. 333-346.
2. V5 Thj Thanh Triic, Hoing Duy Nam, Huynh Vin Min (2011). Birdc diu dinh gii tinh ti^ng rdi loan dong cam miu d bfnh nhan da u tuy xuong tai vifn Huyit hpc - Trayen miu TPHCM. Tap chi Y hpc Vift Nam.38l(5):l9-23.
3. Angtuaco E.J.C., Fassas A.B.T., et al., (2004). Multiple Myeloma: Clinical Review
and Diagnostic Imaging. Radiology.
231(l):ll-23.
Aniari N.A., Owals M, Usha, (2007).
Immunoglobulin Heavy and Light Chain Isotypes in Multiple Myeloma Patients.
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