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1 病例介绍 患者,女,26岁,畏寒,发热半月。于1995年11月21日入院。入院前半月因受凉反复感畏寒、发热,入院前4 d出现恶心、呕吐、腹痛、腹泻,半月来体温37C～40C;既往体健。查体:体温39C,贫血貌,浅表淋巴结未扪及,皮肤无出血点;胸骨无压痛,左肺底少许湿鸣音;心（一）;脐周压痛,肝、牌未扪及。实验室检查:Hb 52～68g/L,WBC(0.3～0.7)×10~9/L,PC(4.0～13)×10~9/L,网织红细胞0.4%,肝肾功能及大小便常规正常,本周氏蛋白尿阴性;蛋白电泳:α球蛋白39.6,α_1 4.2,α_2 16.1,β 8.1,γ32。免疫球蛋白:IgG 19.27g/L,IgA 1.62g/L,IgM 2.49g/L。两次血培养:肠产气杆菌。骨髓涂片:有核细胞增生明显活跃,浆细胞系统极度活跃（占0.97）,其中原始浆细胞占0.75,幼稚浆细胞0.185,浆细胞0.035,瘤细胞体积大,浆深蓝色不透明,核染色质细软,可见1～4个蓝色核仁,核略偏位,核周晕及车轮状结构消
1 case description Patient, female, 26 years old, chills, fever half a month. Admitted to hospital on November 21, 1995. For the first half of admission, the patient felt chills and fever repeatedly because of the cold, and had nausea, vomiting, abdominal pain and diarrhea 4 days before admission. The body temperature was 37C ~ 40C in the past half months. Physical examination: body temperature 39C, anemia appearance, superficial lymph nodes not palpable, the skin no bleeding point; sternum no tenderness, a little left lung wet beep; heart (a); umbilical tenderness, liver, brand palpable. Laboratory tests: Hb 52 ~ 68g / L, WBC 0.3 ~ 0.7 × 10 ~ 9 / L, PC 4.0 ~ 13 × 10 ~ 9 / L, reticulocyte 0.4%, liver and kidney function and urine Normal, this week’s proteinuria negative; protein electrophoresis: α-globulin 39.6, α_1 4.2, α_2 16.1, β 8.1, γ32. Immunoglobulins: IgG 19.27 g / L, IgA 1.62 g / L, IgM 2.49 g / L. Two blood cultures: Enterobacter aerogenes. Bone marrow smear: obvious proliferation of nucleated cells, extremely active plasma cell system (accounting for 0.97), of which 0.75% of primary plasma cells, naive plasma cells 0.185, plasma cells 0.035, tumor cells bulky, dark blue pulp opacity, nuclear chromatin Soft, visible 1 to 4 blue nucleolus, the nucleus slightly offset, nuclear week halo and wheel-shaped structure disappear