血清κ/λ轻链比值及蛋白电泳在诊断多发性骨髓瘤中的临床应用  

The clinical application of serum κ/λ light chain ratio and protein electrophoresis in the diagnosis of multiple myeloma

作　　者：康懿[1] 刘华[1] 王蕾[2] 高锋[1] 

机构地区：[1]上海交通大学附属第六人民医院检验科,上海200233 [2]上海中医药大学附属龙华医院检验科,上海200032

出　　处：《检验医学》2011年第10期675-678,共4页Laboratory Medicine

摘　　要：目的探讨多发性骨髓瘤(MM)患者血清轻链(sLC)κ/λ比值及血清蛋白电泳(SPE)在MM诊断中的临床价值。方法采用速率散射免疫比浊法测定282例MM患者及521例健康对照人群sLC水平并计算κ/λ比值,同时做SPE和免疫固定电泳(IFE)。以临床已确诊为MM的患者分型结果为标准,评价sLC比值联合SPE检测对MM诊断的敏感性和特异性。结果 282例MM患者中145例为IgG型(IgGκ型83例、IgGλ型62例),73例为IgA型(IgAκ型34例、IgAλ型39例),19例为IgM型(IgMκ型14例、IgMλ型5例),45例为轻链型(游离κ型轻链16例、游离λ型轻链29例)。除IgMλ型MM外,其余各类型MM患者sLCκ/λ比值与对照组比较,差异均有统计学意义(P<0.05、P<0.01)。以临床确诊为MM的患者分型结果为标准,单独以sLCκ/λ比值诊断MM的敏感性为61.0%、特异性为95.0%、阳性预测值为90.9%、阴性预测值为89.5%;sLCκ/λ比值联合SPE检测的敏感性为98.0%、特异性为86%、阳性预测值为68.8%、阴性预测值为99.3%。结论 sLC及SPE联合检测对MM的诊断具有较高的敏感性和特异性,且检测方法简便、快速,可在各临床实验室推广应用。Objective To investigate the clinical application of serum light chain（sLC） κ/λ ratio and serum protein electrophoresis（SPE） in the diagnosis of multiple myeloma（MM）.Methods A total of 282 MM patients and 521 healthy controls were enrolled in this study.The sLC levels were measured by immune rate nephelometry,and the κ/λ ratios were calculated.The SPE and immunofixation electrophoresis（IFE） were also performed.MM patients were defined according to clinical diagnosis.The sensitivity and specifity of combined use of sLC ratio and SPE were evaluated. Results Among the 282 MM patients,145 were IgG MM（83 IgGκ MM and 62 IgGλ MM）,73 were IgA MM（34 IgAκ MM and 39 IgAλ MM）,19 were IgM MM（14 IgMκ MM and 5 IgMλ MM）,and 45 were light chain MM（16 free light chain κ MM and 29 free light chain λ MM）.The sLC κ/λ ratios were significantly different between all subgroups of MM patients and controls,except IgMλ MM patients（P〈0.05,P〈0.01）.The sensitivities,specificities,positive predictive values and negative predictive values were 61.0%,95.0%,90.9% and 89.5% for sLC κ/λ ratio alone,and 98.0%,86.0%,68.8% and 99.3% for combined use of sLC κ/λ ratio and SPE.Conclusions The combined determination of sLC κ/λ ratio and SPE shows high sensitivity and specificity in the diagnosis of MM and is simple,rapid and worthy to be widely applied.

关 键 词：免疫球蛋白 游离轻链 总轻链 多发性骨髓瘤 

分 类 号：R446.1[医药卫生—诊断学]