Taino Giuseppe, Buonocore Concetta, Stanga Andrea, Imbriani Marcello
IRCCS Istituti Clinici Scientifici Maugeri, Pavia.
Università degli Studi di Pavia, IRCCS Istituti Clinici Scientifici Maugeri, Pavia.
G Ital Med Lav Ergon. 2020 Dec;42(4):292-297.
The term monoclonal gammopathy refers to a clinical condition characterized by the presence in serum and/or urine of clonal immunoglobulins, i.e. homogeneous immunoglobulins, structurally identical both as a heavy chain and as a light chain, produced by a B cell clone (1). The prevalence of MGUS is low in young subjects (less than 2% of patients with MGUS are less than 40 years of age, while in the population aged over 50 years it is relatively high (3.2%) and increases considerably with age. Although historically considered to be a benign condition, patients with MGUS are at risk to develop multiple myeloma over time. Therefore, MGUS may be framed as a preneoplastic stage of the plasma cell that precedes the possible development of a multiple myeloma. In a limited percentage of cases, it can be considered the asymptomatic pre-malignant stage preceding multiple myeloma (MM) on a probabilistic basis. Few studies have assessed the prevalence of MGUS in people occupationally exposed to pesticides. Several other studies on atomic bomb survivors in Hiroshima and Nagasaki have revealed a possible association with exposure to ionizing radiation (IR). Routine laboratory tests performed on the subjects exposed to the risk factors studied appear to be indicated for workers from the age of 50 years. The finding of a GMUS in the absence of further laboratory alterations is the most frequent finding and does not require further action, if it is not to plan include blood chemistry tests at least every two years. In this situation, no restrictions appear to be justified on the work activity involving the risk of exposure to IR or pesticides. In case of concurrent presence of alterations that may be indicative or suggestive of an increased risk of evolution in a neoplastic way a close periodicity - every 3-6 months - of haematological checks is recommended. In such cases, it appears justified to move away from activities involving exposure to ionizing radiation for a period of time which should be evaluated on the basis of the evolution of the picture and the progress of laboratory tests during the monitoring period.
单克隆丙种球蛋白病是一种临床病症，其特征是血清和/或尿液中存在克隆性免疫球蛋白，即由B细胞克隆产生的重链和轻链在结构上均相同的均质免疫球蛋白（1）。意义未明的单克隆丙种球蛋白病（MGUS）在年轻受试者中的患病率较低（MGUS患者中年龄小于40岁的不到2%，而在50岁以上人群中相对较高（3.2%），且随年龄显著增加。尽管历史上认为MGUS是一种良性病症，但随着时间推移，MGUS患者有发展为多发性骨髓瘤的风险。因此，MGUS可被视为浆细胞的肿瘤前阶段，先于多发性骨髓瘤的可能发生。在有限比例的病例中，基于概率可将其视为多发性骨髓瘤（MM）之前的无症状癌前阶段。很少有研究评估职业接触农药人群中MGUS的患病率。关于广岛和长崎原子弹幸存者的其他几项研究揭示了与接触电离辐射（IR）可能存在关联。对接触所研究风险因素的受试者进行常规实验室检查似乎适用于50岁及以上的工人。在没有进一步实验室改变的情况下发现MGUS是最常见的结果，不需要进一步行动，如果不打算至少每两年进行一次血液化学检查的话。在这种情况下，对于涉及接触IR或农药风险的工作活动，似乎没有理由进行限制。如果同时存在可能表明或提示肿瘤性进展风险增加的改变，建议每3 - 6个月进行密切的血液学检查。在这种情况下，在一段时间内远离涉及接触电离辐射的活动似乎是合理的，这段时间应根据病情演变和监测期间实验室检查的进展来评估。
