Miliani A, Anichini P, di Guglielmo R, Pellegrini G, Firorelli C, Cuccuini A, Cozzolino F, Vercelli D
Nouv Rev Fr Hematol (1978). 1982;24(1):27-33.
Three plasma cell enzymatic reactions--ATPase, acid phosphatase (AP), alpha-naphthyl acetate esterase (alpha-NAE)--were tested in a large number of bone marrow samples from patients with multiple myeloma (MM), benign monoclonal gammapathy (BMG)--idiopathic (iBMG) and secondary (sBMG)--, polyclonal hypergammaglobulinemia (PH), Waldenström's macroglobulinemia (WM) and from normoglobulinemic subjects (NS). The purpose of the present study was to evaluate the significance of these reactions in differential diagnosis of BMG and initial or atypical MM. For each reaction results were expressed as scores and normal limits were statistically established. Our findings in MM, HP and NS are consistent with previous reports (similar enzymatic pattern in NS and PH; depressed ATPase activity, raised AP and alpha-NAE activities in most MM cases). In the BMG class, ATPase activity was normal in about 40% of iBMG, while it was depressed in other cases; most sBMG had diminished ATPase activity. AP patterns were normal for both BMG groups. alpha-NAE activity was normal in 50% of iBMG, while it was raised in the other cases. All the reactions were normal in WM. In a bayesian analysis of cytochemical patterns of NS and MM subjects ATPase showed the highest diagnostic significance, followed by alpha-NAE and AP. ATPase, therefore, seems to be the most useful criterion for the diagnosis of initial MM; low ATPase score BMG patients should therefore be carefully followed-up.
在大量来自多发性骨髓瘤（MM）、良性单克隆丙种球蛋白病（BMG）——特发性（iBMG）和继发性（sBMG）——、多克隆高丙种球蛋白血症（PH）、华氏巨球蛋白血症（WM）患者以及正常球蛋白血症受试者（NS）的骨髓样本中，检测了三种浆细胞酶反应——三磷酸腺苷酶（ATPase）、酸性磷酸酶（AP）、α-萘乙酸酯酶（α-NAE）。本研究的目的是评估这些反应在BMG与初发或非典型MM鉴别诊断中的意义。对于每种反应，结果以分数表示，并通过统计学方法确定正常范围。我们在MM、HP和NS中的研究结果与先前报道一致（NS和PH中酶模式相似；大多数MM病例中ATPase活性降低，AP和α-NAE活性升高）。在BMG类别中，约40%的iBMG中ATPase活性正常，而在其他病例中则降低；大多数sBMG的ATPase活性降低。两个BMG组的AP模式均正常。50%的iBMG中α-NAE活性正常，而在其他病例中则升高。WM中所有反应均正常。在对NS和MM受试者细胞化学模式的贝叶斯分析中，ATPase显示出最高的诊断意义，其次是α-NAE和AP。因此，ATPase似乎是初发MM诊断中最有用的标准；因此，ATPase评分低的BMG患者应仔细随访。
