Value of serum immunoglobulin and serum and urine light chains in early diagnosis of patients with multiple myeloma
-
摘要: 目的 研究血清免疫球蛋白及血、尿液轻链检测对多发性骨髓瘤(MM)患者的早期诊断价值。方法 选择2019年3月至2021年4月诊治的疑似MM患者157例, 根据临床诊断分为MM组62例和非MM组95例, 另选择同期体检的健康志愿者109例作为对照组。检测血清免疫球蛋白G(IgG)、血清及尿液轻链水平, 分析其对MM的诊断效能, 并分析IgG、血清及尿液轻链水平对MM分型和ISS分期的鉴别诊断价值。结果 MM组患者血清IgG水平、血清κ和λ轻链、尿液κ和λ轻链水平均高于非MM组、对照组(P< 0.05)；血清IgG、血/尿液轻链水平联合诊断MM的AUC以及特异度最高(P< 0.05)；血清IgG水平、血清κ和λ轻链、尿液κ和λ轻链水平比较: Ⅲ期>Ⅱ期>Ⅰ期, 差异有统计学意义(P< 0.05)；不同分型患者血清IgG、血清κ和λ轻链、尿液κ和λ轻链水平比较差异无统计学意义(P>0.05)。结论 血清IgG、血/尿液轻链水平在MM患者体内存在异常升高, 三者联合对于MM具有较高的诊断效能, 并可为MM的疾病分期判断提供依据。Abstract: Objective To study the value of serum immunoglobulin and serum and urine light chains in early diagnosis of patients with multiple myeloma(MM).Methods 157 patients suspected of MM were admitted to our hospital between March 2019 and April 2021. According to the clinical diagnosis results, the patients were divided into MM group(62 cases) and non-MM group(95 cases). Meanwhile, 109 healthy volunteers who came to our hospital for physical examination during the same period were selected as the control group. The levels of serum immunoglobulin G(IgG), serum and urine light chains were detected, and their diagnostic efficiencies for MM were analyzed. The value of IgG, serum and urine light chains in MM classification and ISS staging was analyzed.Results The levels of serum IgG, serum κ and λ light chains, urine κ and λ light chains in the MM group were higher than those in the non-MM group and the control group(P< 0.05). The AUC and specificity of combined diagnosis of MM with serum IgG and serum/urine light chains were the highest(P< 0.05). The levels of serum IgG, serum κ and λ light chains, urine κ and λ light chains decreased in order from stage Ⅲ, stage Ⅱ to stage Ⅰ(P< 0.05). There was no statistically significant difference in the levels of serum IgG, serum κ and λ light chains, urine κ and λ light chains between patients with different types(P>0.05).Conclusion The levels of serum IgG and blood/urine light chains were abnormally elevated in patients with MM. The combination of the three may be highly efficient in the diagnosis of MM, which can provide a basis for the diagnosis and classification of MM.
-
Key words:
- immunoglobulin /
- light chain /
- multiple myeloma /
- diagnostic efficiency
-
-
表 1 3组对象血清IgG、血/尿液轻链水平比较
g/L, X±S 分组 例数 IgG 血清κ轻链 血清λ轻链 尿液κ轻链 尿液λ轻链 MM组 62 18.16±4.651) 20.66±5.051)2) 11.96±3.471)2) 9.74±3.631)2) 12.75±3.241)2) 非MM组 95 17.52±4.191) 17.73±4.011) 9.45±2.661) 5.89±1.841) 9.44±3.061) 对照组 109 10.62±2.12 8.74±1.43 4.50±0.99 2.34±0.75 2.85±1.17 F 125.874 277.801 219.005 245.708 348.636 与对照组比较，1)P < 0.05；与非MM组比较，2)P < 0.05。 
下载: 导出CSV
表 2 血清IgG、血/尿液轻链水平对MM的诊断价值
指标 AUC 标准误 渐进Sig 置信区间 敏感度/% 特异度/% IgG 0.545 0.048 0.345 0.451~0.639 29.03 86.32 血清κ轻链 0.663 0.045 0.001 0.574~0.752 67.74 63.16 血清λ轻链 0.701 0.044 < 0.001 0.615~0.787 62.90 73.68 尿液κ轻链 0.826 0.038 < 0.001 0.753~0.900 75.81 82.11 尿液λ轻链 0.783 0.039 < 0.001 0.706~0.860 70.97 81.05 联合诊断 0.910 0.027 < 0.001 0.858~0.962 74.19 95.79
下载: 导出CSV
表 3 不同ISS分期患者血清IgG、血/尿液轻链水平比较
g/L, X±S ISS分期 例数 IgG 血清κ轻链 血清λ轻链 尿液κ轻链 尿液λ轻链 Ⅰ期 28 14.18±2.83 17.17±4.07 9.43±2.85 6.68±1.99 10.15±2.62 Ⅱ期 19 19.66±1.761) 21.76±1.381) 13.19±1.331) 10.59±1.331) 13.78±1.011) Ⅲ期 15 23.68±2.711)2) 25.81±4.721)2) 15.13±2.971)2) 14.39±2.171)2) 16.32±1.601)2) F 74.356 28.310 28.197 86.581 49.241 与Ⅰ期比较，1)P < 0.05；与Ⅱ期比较，2)P < 0.05。
下载: 导出CSV
表 4 不同分型患者血清IgG、血/尿液轻链水平比较
g/L, X±S 疾病分型 例数 IgG 血清κ轻链 血清λ轻链 尿液κ轻链 尿液λ轻链 κ轻链型 33 18.58±3.95 20.67±4.17 13.18±2.68 12.12±2.87 13.18±2.68 λ轻链型 29 17.67±5.36 20.65±5.98 12.26±3.77 11.77±4.09 12.26±3.77 t 0.771 0.018 0.741 0.402 1.123 P 0.444 0.986 0.461 0.689 0.266
下载: 导出CSV
-
[1] 巨小英, 徐华, 常军林, 等. 多发性骨髓瘤患者白蛋白和球蛋白比值对红细胞凝聚及输注的影响[J]. 临床血液学杂志, 2019, 32(8): 612-613. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201908012.htm
[2] 况小红, 童浩, 代明辉, 等. 全球多发性骨髓瘤发病和死亡现状及其与人类发展指数的关系[J]. 现代肿瘤医学, 2021, 29(2): 302-306. doi: 10.3969/j.issn.1672-4992.2021.02.026
[3] 朱晶晶, 陈海飞. 多发性骨髓瘤合并肾功能损害的诊断及治疗[J]. 国际输血及血液学杂志, 2016, 39(6): 530-538. doi: 10.3760/cma.j.issn.1673-419X.2016.06.016
[4] 王加强, 张娟, 王智斌, 等. 多发性骨髓瘤和淋巴瘤患者IgG亚类分析及其与血细胞参数的相关性[J]. 中国实验血液学杂志, 2020, 28(6): 1957-1961. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY202006031.htm
[5] 袁瑞丽, 刘妮, 张凯歌, 等. 血清轻链κ/λ比值在诊断多发性骨髓瘤和原发性肾病中的临床价值[J]. 中国医师杂志, 2016, 18(4): 539-543. doi: 10.3760/cma.j.issn.1008-1372.2016.04.015
[6] Yadav P, Sathick IJ, Leung N, et al. Serum free light chain level at diagnosis in myeloma cast nephropathy-a multicentre study[J]. Blood Cancer J, 2020, 10(3): 28. doi: 10.1038/s41408-020-0295-4
[7] 中国医师协会血液科医师分会, 中华医学会血液学分会, 中国医师协会多发性骨髓瘤专业委员会. 中国多发性骨髓瘤诊治指南(2017年修订)[J]. 中华内科杂志, 2017, 56(11): 866-870. doi: 10.3760/cma.j.issn.0578-1426.2017.11.021
[8] 张佳思, 孙春艳. 伴髓外病变的多发性骨髓瘤发病机制的研究进展[J]. 国际输血及血液学杂志, 2019, 42(3): 212-217. doi: 10.3760/cma.j.issn.1673-419X.2019.03.006
[9] 赵娟, 马乐, 关键虹. 多发性骨髓瘤继发骨髓纤维化的骨髓病理学特征及与疾病预后的关系[J]. 中国实验血液学杂志, 2017, 25(4): 1080-1085. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY201704025.htm
[10] 陈曦, 许荟, 史嘉颖, 等. 血清游离轻链检测方法及其在多发性骨髓瘤诊治中的应用研究进展[J]. 山东医药, 2017, 57(44): 110-112. doi: 10.3969/j.issn.1002-266X.2017.44.036
[11] 姜方毅, 唐炳群, 陈桂明, 等. 尿液轻链检测在多发性骨髓瘤鉴别诊断中的应用[J]. 重庆医学, 2017, 46(A03): 57-59. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYZ201909035.htm
[12] 赵云阳, 安然, 张慧, 等. 免疫球蛋白重/轻链检测在IgA型多发性骨髓瘤患者预后判断中的作用[J]. 临床血液学杂志, 2017, 30(5): 350-352, 357. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201705027.htm
[13] Dejoie T, Corre J, Caillon H, et al. Responses in multiple myeloma should be assigned according to serum, not urine, free light chain measurements[J]. Leukemia, 2019, 33(2): 313-318. doi: 10.1038/s41375-018-0339-y
[14] 肖明锋, 刘基铎, 袁晴, 等. 免疫球蛋白定量检测及蛋白电泳在少见型多发性骨髓瘤诊断中的应用[J]. 检验医学与临床, 2016, 13(15): 2126-2127, 2131. doi: 10.3969/j.issn.1672-9455.2016.15.020
-
图(1)
表(4)
计量
- 文章访问数: 518
- PDF下载数: 499
- 施引文献: 0