secondary monoclonal immunoglobulin disease
Introduction
Introduction to secondary monoclonal immunoglobulin disease Secondary monoclonal immunoglobulinopathy (secondary monoclonal gammopathy), also known as monoclonal immunoglobulinemia associated with non-plasma disease. basic knowledge The proportion of illness: the incidence rate is about 0.0005% - 0.0009% Susceptible people: no special people Mode of infection: non-infectious Complications: hypoglycemia
Cause
Secondary monoclonal immunoglobulin disease etiology
(1) Causes of the disease
Increased monoclonal immunoglobulin can be found in a variety of diseases: autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, scleroderma, pernicious anemia, Crohn's disease, etc.), cancer, ( Colon cancer, lung cancer, prostate cancer, etc.), infectious diseases (Mycobacterium tuberculosis infection, Corynebacterium infection, bacterial endocarditis, cytomegalovirus infection, HIV infection, etc.), liver disease (viral hepatitis, cirrhosis) ), endocrine system diseases (hyperparathyroidism, etc.), metabolic diseases (gosie disease, etc.), myeloproliferative disorders (chronic and acute lymphocytic leukemia, chronic and acute myeloid leukemia, polycythemia vera, etc.) , T-cell lymphoma, etc., there are also reports of monoclonal immunoglobulinemia after chemotherapy, after radiotherapy and after bone marrow transplantation, whether the occurrence of monoclonal immunoglobulin in these various diseases is accidental coincidence, or There is an intrinsic link between the two, and there is no consistent conclusion.
(two) pathogenesis
According to the fact that monoclonal immunoglobulin does not have the specificity of anti-tumor antigen antibody and the existence of monoclonal immunoglobulin after tumor resection, it is generally believed that monoclonal immunoglobulin and tumor are simultaneously coincident, and epidemiological investigation has not found The fact that the incidence of monoclonal immunoglobulinemia in tumor patients is significantly different from that in the normal population supports this view, but a small number of monoclonal immunoglobulins have rheumatoid factor characteristics or participate in the formation of cryoglobulin, indicating autoimmune The pathogenesis of the disease is related. Some monoclonal immunoglobulins in peripheral neuropathy may bind to peripheral myelin phospholipids and may be involved in the pathogenesis. However, most peripheral neuropathy patients do not have monoclonal immunoglobulin, indicating another pathogenesis.
Prevention
Secondary monoclonal immunoglobulin disease prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Secondary monoclonal immunoglobulin disease complications Complications hypoglycemia
Heterologous protein response, hypoglycemia.
Symptom
Secondary monoclonal immunoglobulin disease symptoms Common symptoms Hypoglycemia hemolytic anemia
Secondary monoclonal immunoglobulin increase itself usually does not cause clinical manifestations or signs, the clinical manifestations of patients are mainly related to the primary disease, in a few cases, monoclonal immunoglobulin has anti-erythrocytes, anti-clotting factors or anti-insulin Characteristics, can cause hemolytic anemia, acquired vascular pseudohemophilia or hypoglycemia.
Examine
Secondary monoclonal immunoglobulin disease examination
Peripheral blood
Blood routine is associated with associated diseases, red blood cells, hemoglobin, white blood cells, and platelets are normal or slightly lower.
2. Serum protein electrophoresis showed in the region or fast region, there is M protein in region, M protein concentration is generally lower than 3g / L (IgG <2g / L, IgA, IgM <1g / L), immunoelectrophoresis shows M protein Mostly IgG type, followed by IgM, IgA, IgD is rare, light chain is mainly kappa chain.
3. Urine-week protein is mostly negative or small.
4. Biochemical examination, there may be low blood sugar.
5. Bone marrow examination
Bone marrow smear examination is generally normal, plasma cells can be slightly increased, but the morphology is close to normal, the number is <10%.
According to the condition, clinical manifestations, symptoms, signs, choose to do ECG, X-ray, CT, B-ultrasound and other tests.
Diagnosis
Diagnosis and diagnosis of secondary monoclonal immunoglobulin disease
According to the appearance of monoclonal immunoglobulin in the blood or the appearance of monoclonal immunoglobulin light chain in the urine, the primary disease exists, and the malignant plasma cell disease is ruled out, and the disease can be diagnosed.
The disease is identified with multiple myeloma.
