Transcription of 39．多発性骨髄腫および 免疫増殖性新生物
1 39 .. 1992 International Classification of . Diseases 10th Revision(ICD-10) M IgG IgA IgM IgD IgE . ( 5 ) . 2 2 . 3 . Waldenstr m . Waldenstr m Monoclonal gammopathy of undeter- H mined significance(MGUS) M . H ( ) ( 1)1) M . M .. M . M . (monoclonal gammopathy M ) M.. M . ( . 2)2) 4) M . M ( 3) . M 1 . B 5) .. 1 M 1).. POEMS* (Crow-Fukase ).. Waldenstr m ( ). (H ). Monoclonal gammopathy of undetermined significance(MGUS). M . *polyneuropathy organomegaly endocrinopathy M-protein and skin changes (M . ). 162 . 39 . 2 M 2) 4).. 1 . 2 30%. 3 M : IgG IgA Bence-Jones 1g/24 . ( ).. 1 10 30%. 2 M 3 . 3 . 4 : IgM 50mg/dl IgA 100mg/dl IgG 600mg/dl . 1 1 ( 1 1 ) . 1 2 3 .. 1 (3 ) . 2 M : IgG 7g/dl IgA 5g/dl 3.
2 Karnofsky performance status 70%. 10g/dl .. 2 . 1 . 2 : 10 30%. Monoclonal gammopathy of undetermined significance(MGUS). M . M . 1 M : IgG IgA . Bence-Jones 1g/24 . 2 10%. 3 . 4 . 3 .. M (IgG IgA IgD IgE ) M (IgM). (Bence-Jones ) . 163 . 2003 . 3) : .. ( ) . M M-band M . M-peak 4) : M M . IgM . M . Bence-Jones ( M . ) 5) : .. Bence-Jones . ( 1 2) Bence-Jones . M .. 6) : . (immunofixation) (capillary electro- . 6). phoresis) immunosubtraction 25 50 . 1) : Bence-Jones Bence-Jones . Bence-Jones .. 2) ( ) : M .. M-peak 2 . Bence-Jones . 1 2 7 . X . 1 3 . M 3 7 . 10 30% . M ( ). M . X . M . ( ). 2 .. CT. MRI.. 1 M , . 164 . 39 . 165 . 2003 . 4 M .. MGUS* .. 1 1 2 2 3 1 1 . 1 1 3 3 3 1 3 . 1 1 3 3 6 1 1 . 2 2 3 3 1 2 2.
3 2 2 3 3 1 2 2 . 2 2 6 6 1 1 ** 3 **. 1 4 6 6 1 2 ** 6 **. M . 2- 6 6 6 M .. M . 1 6 6 6 M .. MRI 2 1 1 M . 1) . 2) *MGUS : monoclonal gammopathy of undetermined significance M . **Bence-Jones .. M ( 2) . (2) M . 2- .. 1) Alexanian R Weber D Liu F : Differential diagnosis of ( 4) monoclonal gammopathies. Arch Pathol Lab Med 123 : 108 113, 1999. 2) Foerster J, Paraskevas F : Multiple myeloma. Wintrobe's Clinical Hematology(Lee GR et al ed.) 10th ed. Williams & Wilkins, 1999. p2631 2680. 3) Barlogie B, Shaughnessy J, Munshi N, Epstein : Plasma cell myeloma. Williams Hema-tology(Beutler E et al ed.), 6th ed. McGraw-Hill, 2001. p1279 1304. 4) , : IgG , IgA , BJP .. 22 : 403. 407, 1998. 5) UK Myeloma Forum Guideline on the M diagnosis and management of multiple myeloma ( 4) ( ).
4 MGUS M 6) Kyle RA : Sequence of testing for monoclonal 1 1% gammopathies. Arch Pathol Lab Med 123 : 114 118, 1999. 7) M 7) Kyle RA, et al A long-term study of prognosis in 10 monoclonal gammopathy of undetermined significance . N Engl J Med 346 564 569 2002. ( 15 7 ). M . 166.
