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摘要: 目的:探讨血清游离轻链(sFLC)检测在多发性骨髓瘤(MM)患者中的变化和临床应用价值。方法:选择116例MM患者,留取初诊和联合化疗后的血清样本,采用免疫散射法测定sFLC,同时应用免疫固定电泳(IFE)检测血清M蛋白,分析sFLC在MM患者诊断和预后中的作用。结果:初诊时116例MM患者sFLC或其比值均有异常改变,且ISS Ⅲ期患者sFLC水平显著高于ISS Ⅰ期和Ⅱ期患者,而IFE检测血清M蛋白阳性率为87.3%;联合化疗后血清游离轻链κ或λ水平显著下降(P<0.05),其中有效组患者sFLCκ/λ比值恢复正常为70.2%,进展期患者sFLC水平有明显降低但仍维持较高水平,且sFLCκ/λ比值有2例恢复正常,高sFLC患者可能具有更高的肿瘤负荷和更强的侵袭性,可提示患者预后不良。结论:sFLC检测在MM的早期诊断、疗效评估以及微小肿瘤负荷检测等方面有重要的临床应用价值。Abstract: Objective:To investigate the changes and clinical application value of serum free light chain(sFLC)detection in patients with multiple myeloma(MM).Method:A total of 116 MM patients were enrolled.Serum samples from the initial diagnosis and combined chemotherapy were used.The sFLC was determined by immunoscopy.The serum M protein was detected by immunofixation electrophoresis(IFE).The role of sFLC in the diagnosis and prognosis of MM patients were analyzed.Result:The sFLC or its ratio was abnormally changed in 116 MM patients at the initial diagnosis,and the sFLC level in patients with stage Ⅲ ISS was significantly higher than that in patients with ISS Ⅰ and Ⅱ.The positive rate of serum M protein in IFE was 87.3%.Serum free after chemotherapy.The light chain κ or λ level decreased significantly(P<0.05).The sFLCκ/λ ratio returned to normal in the effective group which was 70.2%.The sFLC level in the advanced patients was significantly reduced but still maintained at a high level,and the sFLCκ/λ ratio of 2 cases was return to normal,and patients with high sFLC may have higher tumor burden and greater invasiveness,suggesting a poor prognosis.Conclusion:sFLC detection might have important clinical application value in the early diagnosis,therapeutic evaluation and micro-tumor load detection of MM.
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Key words:
- multiple myeloma /
- serum free light chain /
- immunofixation electrophoresis
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