每日一题_2023.06.12

A 64-year-old woman presents to her primary care physician with fatigue, weakness, and a weight loss of 4.5 kg (10 lb) in the past four months. Also, her vision has deteriorated over that time, and she has had several severe nose- bleeds. Physical examination demonstrates hepatosplenomegaly, and laboratory tests show an increased total protein level. Serum protein electrophoresis reveals a large spike in the gamma region. A skeletal survey is negative. Which of the following is the most likely diagnosis?

一名64岁女性因疲劳、虚弱和在过去4个月内体重减轻4.5 kg (10 lb)到其初级保健医师处就诊。同时，她的视力在那段时间里恶化了，而且她有几次严重的鼻出血。体格检查示肝脾肿大，实验室检查示总蛋白水平升高。血清蛋白电泳显示γ区有一个大的峰。骨骼检查为阴性。下列哪一项是最可能的诊断?

(A)  Chronic lymphocytic leukemia 慢性淋巴细胞白血病

(B)  Diabetes mellitus 糖尿病

(C)  Monoclonal gammopathy of undetermined significance意义未明的单克隆丙种球蛋白病

(D)  Multiple myeloma 多发性骨髓瘤

(E)  Waldenström macroglobulinemia Waldenström巨球蛋白血症

答案解析：

本文描述的疾病是Waldenström巨球蛋白血症，其特征是虚弱、体重减轻、血清蛋白电泳上的单克隆M峰(被视为γ区的大峰)和高黏滞综合征(表现为鼻血、头痛和视力障碍)。高黏度是由血液中b细胞肿瘤产生的大量IgM蛋白引起的。这些大蛋白质干扰微血管和细胞过程，导致血管损伤，导致头痛，因为大脑血流量受损和视力障碍，因为眼睛血流量差。此外，循环IgM蛋白可与凝血因子结合并抑制凝血因子，导致出血增加。

正确答案：E