Taino Giuseppe, Bordini Lorenzo, Sarto Cecilia, Porro Sara, Chirico Francesco, Oddone Enrico, Imbriani Marcello
Istituti Clinici Scientifici Maugeri IRCSS, Occupational Medicine Hospital Unit (UOOML), Institute of Pavia, Italy.
Fondazione IRCCS Policlinico Ca' Granda Ospedale Maggiore - Milano, Italy.
G Ital Med Lav Ergon. 2019 Jul;41(3):202-207.
Monoclonal gammopathy of uncertain significance (MGUS) identifies a clinically asymptomatic and laboratory-based situation characterized by a modest monoclonal component (MC). In a limited percentage of cases, on a probabilistic basis, the asymptomatic genepremalignant stage could lead to multiple myeloma (MM). Materials and Methods. Based on literature data and available Guidelines on the subject, the diagnostic criteria and a methodological path are here suggested to the Occupational Physician to formulate a judgment of suitability for the task with exposure risk to RI or pesticides. Results. Some studies have evaluated the prevalence of MGUS in subjects exposed professionally to pesticides. Numerous other studies conducted on the survivors of the atomic bombing of Hiroshima and Nagasaki have highlighted a possible association with exposure to ionizing radiation (IR). The guidelines relating to the diagnosis and management of MGUS cases (with respect to the potential evolution in MM allow) to draw important operational indications for the competent/authorized physician. Conclusions. The routinely use of laboratory tests for subjects exposed to the studied risk factors is generally indicated starting from the worker's 50 years of age. The finding of a MGUS in the absence of further laboratory alterations represents the situation most frequently and does not require further measures, other than those of foreseeing even blood controls at least every two years. In this situation, there are no justified restrictions on work activities with exposure risks to IR or pesticides. If alterations suggestive for an increased risk of evolution in a neoplastic way could be identified, a close periodicity - every 3-6 months - of haematological checks is recommended. In these cases, it appears justified an abstention from activities involving exposure to ionizing radiation for a period of time that will be evaluated based on the evolution of the framework and by the progress of laboratory tests in the monitored period.
意义未明的单克隆丙种球蛋白病（MGUS）是一种临床无症状且基于实验室检查的情况，其特征为存在少量单克隆成分（MC）。在有限比例的病例中，基于概率，这种无症状的基因前体恶性阶段可能会发展为多发性骨髓瘤（MM）。材料与方法。基于文献数据和关于该主题的现有指南，本文向职业医师建议了诊断标准和一套方法路径，以便对从事有辐射或农药暴露风险工作的人员进行适用性判断。结果。一些研究评估了职业性接触农药人群中MGUS的患病率。在广岛和长崎原子弹爆炸幸存者中进行的大量其他研究突出了与电离辐射（IR）暴露之间可能存在的关联。与MGUS病例的诊断和管理相关的指南（考虑到其向MM发展的潜在可能性）为有资质/获授权的医师提供了重要的操作指示。结论。对于接触所研究风险因素的人员，一般建议从50岁起常规进行实验室检查。在没有进一步实验室异常的情况下发现MGUS是最常见的情况，除了至少每两年进行一次血液检查外，不需要采取其他措施。在这种情况下，对于有辐射或农药暴露风险的工作活动不存在合理的限制。如果能够识别出提示肿瘤性进展风险增加的异常情况，建议每3 - 6个月进行一次密切的血液学检查。在这些情况下，基于病情发展和监测期内实验室检查结果，一段时间内避免从事涉及电离辐射暴露的活动似乎是合理的。
