Abe Y, Muta K, Kato S, Sadamura S, Nishimura J, Nawata H, Takeichi N, Sakai K
Third Department of Internal Medicine, Faculty of Medicine, Kyushu University.
Rinsho Ketsueki. 1991 Nov;32(11):1458-62.
A 58-year-old female was admitted to our hospital because of anemia in March 1987. Monoclonal protein (IgA, kappa) was detected and a diagnosis of multiple myeloma was made. Partial remission was obtained after VAD therapy with alpha-interferon. In December 1989, she was readmitted because of a pathological fracture of the left humerus. A white blood cell count was 4400/microliters with 30% myeloma cells and the urine protein (Bence Jones protein) was 26 g/day. Systemic chemotherapy was not effective. She developed pleural and pericardial effusions, bone mass, disturbance of consciousness and died of respiratory failure only 3 months after readmission. The pleural and pericardial fluids contained many myeloma cells. c-myc gene rearrangement was detected in myeloma cells obtained from the pleural fluid using c-myc exon1 and exon2 probes. The levels of interleukin-6 (IL-6) measured by ELISA was 107.4 pg/ml in serum, 56.2 pg/ml in pleural fluid and 780.0 pg/ml in pericardial fluid. Because of the lack of any overt infectious focus, the level of IL-6 appears to have been related to aggressive proliferation of myeloma cells. It was of interest that C-reactive protein, induced by IL-6, was a good marker reflecting disease activity.
一名58岁女性于1987年3月因贫血入院。检测到单克隆蛋白（IgA，κ链），诊断为多发性骨髓瘤。采用α干扰素进行VAD治疗后获得部分缓解。1989年12月，她因左肱骨病理性骨折再次入院。白细胞计数为4400/微升，骨髓瘤细胞占30%，尿蛋白（本周氏蛋白）为26克/天。全身化疗无效。她出现了胸腔和心包积液、骨质破坏、意识障碍，入院仅3个月后死于呼吸衰竭。胸腔和心包积液中含有许多骨髓瘤细胞。使用c-myc外显子1和外显子2探针，在从胸腔积液中获取的骨髓瘤细胞中检测到c-myc基因重排。通过ELISA检测的白细胞介素-6（IL-6）水平在血清中为107.4皮克/毫升，在胸腔积液中为56.2皮克/毫升，在心包积液中为780.0皮克/毫升。由于缺乏任何明显的感染病灶，IL-6水平似乎与骨髓瘤细胞的侵袭性增殖有关。有趣的是，由IL-6诱导产生的C反应蛋白是反映疾病活动的良好标志物。
