Veyssier P, Zylberait D, Schuller E
Rev Med Interne. 1983 Jun;4(2):177-83. doi: 10.1016/s0248-8663(83)80012-5.
The authors compared 9 cases of myeloma and 2 cases of Waldenström's disease with 10 cases of benign monoclonal gammapathies. None of the patients (except one) had neurological involvement; one patient hab diabetes. The study was focused on the immunoglobulins and proteins in the CSF. The following observations were made: - The CSF protein was raised in 8 out of the 11 malignant gammopathies and in 5 out of the 10 benign gammopathies; - An identical monoclonal protein was found in the CSF and serum in all the cases of malignant gammopathies. In the cases considered to be benign, the results were less concordant: one IgM lymphoma had normal CSF; three IgG dysglobulinemias had different immunoglobulins proteins in their CSF: - The mean CSF immunoglobulin level was much higher in the myeloma patients than in the benign gammopathies; - A number of findings suggest intrathecal secretion (at least in the malignant gammopathies). This is also true in a good number of the benign gammopathy cases. Direct tumoural invasion of the CSF may be more common than generally supposed. However, the study of CSF immunoglobulins alone does not establish the diagnosis of malignant dysglobulinemia. Nevertheless, the authors consider that the finding of intrathecal secretion of immunoglobulin, especially in patients with a discordance in FAB and FC fractions, should lead to a closer follow-up of these patients.
作者将9例骨髓瘤和2例华氏巨球蛋白血症患者与10例良性单克隆丙种球蛋白病患者进行了比较。除1例患者外，所有患者均无神经受累情况；1例患者患有糖尿病。该研究聚焦于脑脊液中的免疫球蛋白和蛋白质。得出了以下观察结果：- 11例恶性丙种球蛋白病中有8例脑脊液蛋白升高，10例良性丙种球蛋白病中有5例脑脊液蛋白升高；- 在所有恶性丙种球蛋白病病例的脑脊液和血清中均发现了相同的单克隆蛋白。在被认为是良性的病例中，结果不太一致：1例IgM淋巴瘤患者的脑脊液正常；3例IgG异常球蛋白血症患者的脑脊液中有不同的免疫球蛋白：- 骨髓瘤患者的脑脊液免疫球蛋白平均水平远高于良性丙种球蛋白病患者；- 一些发现提示存在鞘内分泌（至少在恶性丙种球蛋白病中）。在许多良性丙种球蛋白病病例中也是如此。脑脊液的直接肿瘤侵犯可能比一般认为的更为常见。然而，仅对脑脊液免疫球蛋白的研究并不能确诊恶性异常球蛋白血症。尽管如此，作者认为免疫球蛋白鞘内分泌的发现，尤其是在FAB和FC组分不一致的患者中，应促使对这些患者进行更密切的随访。
